Healthcare Provider Details

I. General information

NPI: 1700802485
Provider Name (Legal Business Name): JAMES M FUENDELING PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 N GREEN ACRES RD SUITE C
FAYETTEVILLE AR
72703-2619
US

IV. Provider business mailing address

2013 N GREEN ACRES RD SUITE C
FAYETTEVILLE AR
72703-2619
US

V. Phone/Fax

Practice location:
  • Phone: 479-422-4489
  • Fax: 479-444-6770
Mailing address:
  • Phone: 479-422-4489
  • Fax: 479-444-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01-15P
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number01-15P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: