Provider Demographics
NPI:1447871934
Name:WHITED, LAURA BETH (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:WHITED
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN,RN
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-1235
Practice Address - Street 1:606 W WILBUR MILLS AVE
Practice Address - Street 2:
Practice Address - City:KENSETT
Practice Address - State:AR
Practice Address - Zip Code:72082-9051
Practice Address - Country:US
Practice Address - Phone:501-742-5697
Practice Address - Fax:501-742-3031
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR239760758Medicaid