Healthcare Provider Details

I. General information

NPI: 1164635447
Provider Name (Legal Business Name): GUY FENTER EDUCATION SERVICE COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 HIGHWAY 22 E SUITE A
BRANCH AR
72928-9648
US

IV. Provider business mailing address

3010 HIGHWAY 22 E SUITE A
BRANCH AR
72928-9648
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-2191
  • Fax:
Mailing address:
  • Phone: 479-965-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier117196743
Identifier TypeOTHER
Identifier StateAR
Identifier IssuerTHERAPY

VIII. Authorized Official

Name: ROY HESTER
Title or Position: DIRECTOR
Credential:
Phone: 479-965-2191