Healthcare Provider Details

I. General information

NPI: 1255436549
Provider Name (Legal Business Name): VERONA TICE BROWN-BEBOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 HEBER SPRINGS RD N
CONCORD AR
72523-9561
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 844-291-4901
  • Fax: 870-895-2164
Mailing address:
  • Phone: 870-856-1202
  • Fax: 870-856-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC6130
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: