Healthcare Provider Details

I. General information

NPI: 1003753757
Provider Name (Legal Business Name): DARDANELLE REGIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDY TALLEY
Title or Position: CONTROLLER
Credential:
Phone: 479-229-6191