Provider Demographics
NPI:1487960258
Name:GREESON, IRIS MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:MICHELLE
Last Name:GREESON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:314-364-7595
Mailing Address - Fax:501-321-4057
Practice Address - Street 1:1662 HIGDON FERRY RD STE 230
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-9581
Practice Address - Fax:501-520-4212
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185696758Medicaid
AR5V318OtherBLUE CROSS
AR5V318OtherBLUE CROSS