Healthcare Provider Details

I. General information

NPI: 1457772279
Provider Name (Legal Business Name): HEATHER LIENHART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 11/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N REYNOLDS RD
BRYANT AR
72022-3034
US

IV. Provider business mailing address

PO BOX 2109
RUSSELLVILLE AR
72811-2109
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-2322
  • Fax:
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-967-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberOTR2323
License Number StateAR

VIII. Authorized Official

Name: KARLA WHIFFEN
Title or Position: ACCOUNTANT
Credential:
Phone: 479-967-2322