Provider Demographics
NPI:1396551412
Name:TARBUTTON, MALLORY RUTH (FNP-C)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:RUTH
Last Name:TARBUTTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-9151
Mailing Address - Country:US
Mailing Address - Phone:870-362-0914
Mailing Address - Fax:
Practice Address - Street 1:1233 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4245
Practice Address - Country:US
Practice Address - Phone:479-636-9235
Practice Address - Fax:479-751-2878
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily