Provider Demographics
NPI:1427421288
Name:CESARE, CARIE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:CARIE
Middle Name:
Last Name:CESARE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1110 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4164
Practice Address - Country:US
Practice Address - Phone:870-205-2000
Practice Address - Fax:870-205-2001
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901376363LX0001X
ARA005322363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR224950758Medicaid