Provider Demographics
NPI:1285094052
Name:TINER, ALLISON (APRN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TINER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-852-1363
Mailing Address - Fax:
Practice Address - Street 1:2526 HIGHWAY 65 S STE 203
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6678
Practice Address - Country:US
Practice Address - Phone:501-745-4914
Practice Address - Fax:501-745-6374
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004690OtherCERTIFIED NURSE PRACTITIONER LICENSE NUMBER