Healthcare Provider Details

I. General information

NPI: 1376758029
Provider Name (Legal Business Name): JANELL THOMPSON VINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 UNITED DR STE 120
CONWAY AR
72032
US

IV. Provider business mailing address

1122 E MAIN ST SUITE 6
PHILADELPHIA MS
39350-2348
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6892
  • Fax:
Mailing address:
  • Phone: 601-656-9900
  • Fax: 601-656-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2118
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: