Provider Demographics
NPI:1144295833
Name:SCARBROUGH, TAD (APRN-C, DC)
Entity type:Individual
Prefix:MR
First Name:TAD
Middle Name:
Last Name:SCARBROUGH
Suffix:
Gender:M
Credentials:APRN-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-0572
Mailing Address - Country:US
Mailing Address - Phone:870-238-8707
Mailing Address - Fax:870-533-5573
Practice Address - Street 1:1901 KILLOUGH RD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4112
Practice Address - Country:US
Practice Address - Phone:870-238-8707
Practice Address - Fax:870-533-5573
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1544111N00000X
AR216876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143884718Medicaid
AR158844718Medicaid
AR158844718Medicaid
AR143884718Medicaid