Provider Demographics
NPI:1487376935
Name:QUATTLEBAUM, PAULA C (APRN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:C
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:C
Other - Last Name:SPELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 ROLLING MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9366
Mailing Address - Country:US
Mailing Address - Phone:870-403-3836
Mailing Address - Fax:
Practice Address - Street 1:1003 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4811
Practice Address - Country:US
Practice Address - Phone:501-653-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health