Healthcare Provider Details

I. General information

NPI: 1689569352
Provider Name (Legal Business Name): BREEDLOVE WOUND CARE OF ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 N SAINT LOUIS
BATESVILLE AR
72501-8467
US

IV. Provider business mailing address

PO BOX 1129
TATUM TX
75691-1129
US

V. Phone/Fax

Practice location:
  • Phone: 903-947-2020
  • Fax: 903-352-3665
Mailing address:
  • Phone: 903-947-2020
  • Fax: 903-352-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANN BREEDLOVE
Title or Position: OWNER
Credential:
Phone: 903-947-2020