Healthcare Provider Details

I. General information

NPI: 1093431348
Provider Name (Legal Business Name): JOHN WINDHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 S 10TH ST
ARKADELPHIA AR
71923-7012
US

IV. Provider business mailing address

PO BOX 3
ARKADELPHIA AR
71923-0003
US

V. Phone/Fax

Practice location:
  • Phone: 888-404-0367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number23194
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: