Basic Information
Provider Information
NPI: 1710588462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCQUAY
FirstName: ELIZABETH
MiddleName: JEAN
NamePrefix: MS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1960
Address2:  
City: JONESBORO
State: AR
PostalCode: 724031960
CountryCode: US
TelephoneNumber: 8709368000
FaxNumber: 8709343677
Practice Location
Address1: 225 E WASHINGTON AVE
Address2:  
City: JONESBORO
State: AR
PostalCode: 724013111
CountryCode: US
TelephoneNumber: 8702071630
FaxNumber: 8702076581
Other Information
ProviderEnumerationDate: 11/07/2020
LastUpdateDate: 08/31/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/31/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X212864ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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