Healthcare Provider Details

I. General information

NPI: 1174961239
Provider Name (Legal Business Name): FORE FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N MAIN ST
CAVE CITY AR
72521-9700
US

IV. Provider business mailing address

307 N MAIN ST
CAVE CITY AR
72521-9700
US

V. Phone/Fax

Practice location:
  • Phone: 870-283-5550
  • Fax:
Mailing address:
  • Phone: 870-283-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. AMBER L FORE
Title or Position: OWNER
Credential: FNP
Phone: 870-283-5550