Provider Demographics
NPI:1487250775
Name:ROSE, JOHNATHAN NOBLE (APRN- CNP)
Entity type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:NOBLE
Last Name:ROSE
Suffix:
Gender:M
Credentials:APRN- CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 900
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6331
Mailing Address - Country:US
Mailing Address - Phone:501-224-1135
Mailing Address - Fax:
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 900
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6331
Practice Address - Country:US
Practice Address - Phone:501-224-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212622363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care