Individual
MARY A LINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
620 BROADWAY ST, VAN BUREN, AR 72956-5830
(479) 474-5061
(479) 922-2007
Mailing address
620 BROADWAY ST, VAN BUREN, AR 72956-5830
(479) 474-5061
(479) 922-2007
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA383
AR
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179073741
—
AR
05
—
200257920A
—
OK
Enumeration date
08/14/2009
Last updated
10/04/2023
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