Individual
RICKEY EDNA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1016 N FOURCHE AVE, PERRYVILLE, AR 72126-8545
(501) 238-1284
(501) 679-8970
Mailing address
4196 HIGHWAY 62 412 STE A, HARDY, AR 72542-8002
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
A005560
AR
Other
Enumeration date
03/06/2018
Last updated
12/09/2024
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