Basic Information
| Provider Information | |||||||||
| NPI: | 1700395225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEOH | ||||||||
| FirstName: | LIBERTY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 S 74TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729035156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143647595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 DANIEL DR | ||||||||
| Address2: | |||||||||
| City: | BOONEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796752455 | ||||||||
| FaxNumber: | 4796754940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2017 | ||||||||
| LastUpdateDate: | 09/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A005369 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.