Basic Information
| Provider Information | |||||||||
| NPI: | 1174799258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | READ | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 497 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720060497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703472534 | ||||||||
| FaxNumber: | 8703472023 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 E WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703335476 | ||||||||
| FaxNumber: | 8703335475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 09/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C7-0004055 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | E-7511 | AR | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | C7-0004055 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | E-7511 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 193847003 | 05 | AR | MEDICAID |