Healthcare Provider Details

I. General information

NPI: 1366168205
Provider Name (Legal Business Name): CARLEY J VALLANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 DAVID ST
CORNING AR
72422-7268
US

IV. Provider business mailing address

602 DAVID ST
CORNING AR
72422-7268
US

V. Phone/Fax

Practice location:
  • Phone: 870-857-3655
  • Fax:
Mailing address:
  • Phone: 870-857-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: