Individual
ALISSA WADDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
401 EAST ST, TEXARKANA, AR 71854-6507
(870) 216-1223
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1021396
TX
363LF0000X
Family Nurse Practitioner
Primary
214732
AR
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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