Healthcare Provider Details

I. General information

NPI: 1679641997
Provider Name (Legal Business Name): JOHN HARRISON BONDHUS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 DENISON ST STE 2
CONWAY AR
72034-6127
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 501-504-2330
  • Fax: 501-504-2061
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA202
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: