Individual
MRS. THEODORA L SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADVANCED PRACTICE NU
Contact information
Practice address
9755 W. STATE HIGHWAY 22, RATCLIFF, AR 72951-9000
(479) 635-5300
(479) 635-2010
Mailing address
PO BOX 130, RATCLIFF, AR 72951-0130
(479) 635-5300
(479) 635-4700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A01027
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A004
TRICARE
—
Enumeration date
01/30/2006
Last updated
10/02/2007
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