Healthcare Provider Details

I. General information

NPI: 1083558522
Provider Name (Legal Business Name): SSK HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 W MAIN ST STE B
CABOT AR
72023-7479
US

IV. Provider business mailing address

13223 HIGHWAY 5
CABOT AR
72023-7017
US

V. Phone/Fax

Practice location:
  • Phone: 501-605-8888
  • Fax:
Mailing address:
  • Phone: 870-918-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. SMOKEY MCMAHAN
Title or Position: CFO
Credential:
Phone: 870-918-6152