Individual
MS. DONNA MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2012 S PROMENADE BLVD, ROGERS, AR 72758
(479) 616-1485
(479) 239-0536
Mailing address
2012 S PROMENADE BLVD, ROGERS, AR 72758-9073
(479) 616-1485
(479) 239-0536
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AO1582
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148362758
—
AR
05
—
426270807
—
MO
01
—
P00378001
RAILROAD MEDICARE
AR
Enumeration date
05/23/2006
Last updated
04/11/2019
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