Healthcare Provider Details

I. General information

NPI: 1427426204
Provider Name (Legal Business Name): ALPHA HORN CLASSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 SE 2ND ST
BRYANT AR
72022-4062
US

IV. Provider business mailing address

PO BOX 25851
LITTLE ROCK AR
72221-5851
US

V. Phone/Fax

Practice location:
  • Phone: 501-240-3579
  • Fax: 501-847-3010
Mailing address:
  • Phone: 501-240-3579
  • Fax: 501-847-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number21420274
License Number StateAR

VIII. Authorized Official

Name: MS. RENEE MACSHALLE WELLS
Title or Position: CERTIFIED DIABETES EDUCATOR
Credential: REGISTERED NURSE
Phone: 501-240-3579