Basic Information
| Provider Information | |||||||||
| NPI: | 1932164084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABINE | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | A.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4747 DUSTY LAKE DR | ||||||||
| Address2: | STE G1 | ||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716039056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705366600 | ||||||||
| FaxNumber: | 8708507959 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 NORTH BLAKE ST | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705366600 | ||||||||
| FaxNumber: | 8708507959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A01480 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5W332 | 01 | AR | MEDICARE | OTHER | P25891 | 01 | AR | UPIN | OTHER | 157705758 | 05 | AR | MEDICAID |