Provider Demographics
NPI:1295536936
Name:RICE, ROSIE LENETTER (MD)
Entity type:Individual
Prefix:
First Name:ROSIE
Middle Name:LENETTER
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7558
Mailing Address - Country:US
Mailing Address - Phone:501-786-1759
Mailing Address - Fax:501-786-1759
Practice Address - Street 1:2501 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7558
Practice Address - Country:US
Practice Address - Phone:479-448-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00000207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1477549756Medicaid
AR1831130616OtherMEDICARE ID-TYPE UNSPECIFIED (04)
AR1093750671Medicaid
AR1639978950Medicaid
AR1932872975Medicaid