Provider Demographics
NPI:1285728139
Name:WOMACK, ELAINE (RNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:WOMACK
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24801 KNABE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5244
Mailing Address - Country:US
Mailing Address - Phone:501-663-0490
Mailing Address - Fax:501-663-5948
Practice Address - Street 1:2 LILE CT
Practice Address - Street 2:SUITE 102-B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6221
Practice Address - Country:US
Practice Address - Phone:501-224-8810
Practice Address - Fax:501-224-9076
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARP01019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner