Provider Demographics
NPI:1992314660
Name:ARIQAT, NADIA (PA-C)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:ARIQAT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W PARKVIEW ST STE 2K
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-8598
Mailing Address - Country:US
Mailing Address - Phone:417-328-7000
Mailing Address - Fax:
Practice Address - Street 1:1155 W PARKVIEW ST STE 2K
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-8598
Practice Address - Country:US
Practice Address - Phone:417-328-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57945363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant