Healthcare Provider Details

I. General information

NPI: 1821789785
Provider Name (Legal Business Name): HAERTLING FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 23RD ST
BATESVILLE AR
72501-6037
US

IV. Provider business mailing address

940 23RD ST
BATESVILLE AR
72501-6037
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4341
  • Fax: 870-569-4004
Mailing address:
  • Phone: 870-569-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC BENJAMIN HAERTLING
Title or Position: OWNER
Credential: APRN
Phone: 870-598-4075