Healthcare Provider Details

I. General information

NPI: 1831043652
Provider Name (Legal Business Name): DARDANELLE REGIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 3RD ST STE 2
DARDANELLE AR
72834-3802
US

IV. Provider business mailing address

PO BOX 578
DARDANELLE AR
72834-0578
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-4677
  • Fax: 479-229-6162
Mailing address:
  • Phone: 479-229-4677
  • Fax: 479-229-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: BRANDY TALLEY
Title or Position: CONTROLLER
Credential:
Phone: 479-229-4677