Healthcare Provider Details

I. General information

NPI: 1073156741
Provider Name (Legal Business Name): THE GUINN CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 W HILLSBORO ST STE B
EL DORADO AR
71730-6806
US

IV. Provider business mailing address

PO BOX 11898
EL DORADO AR
71730-0037
US

V. Phone/Fax

Practice location:
  • Phone: 870-814-4113
  • Fax: 501-492-6477
Mailing address:
  • Phone: 870-814-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDANCE MARIE GUINN
Title or Position: PMHNP-BC, APRN-CNP/OWNER
Credential: APRN-CNP
Phone: 870-814-4113