Healthcare Provider Details

I. General information

NPI: 1912231093
Provider Name (Legal Business Name): ROBBY PLYMALE MHPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 MAYO DR
BARLING AR
72923-1660
US

IV. Provider business mailing address

3352 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

V. Phone/Fax

Practice location:
  • Phone: 479-494-5700
  • Fax: 479-484-9994
Mailing address:
  • Phone: 479-521-1427
  • Fax: 479-521-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: