Healthcare Provider Details

I. General information

NPI: 1932978954
Provider Name (Legal Business Name): JONATHON FARLIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 N QUALITY LN
FAYETTEVILLE AR
72703-5521
US

IV. Provider business mailing address

2683 N QUALITY LN
FAYETTEVILLE AR
72703-5521
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-1840
  • Fax: 479-442-0991
Mailing address:
  • Phone: 479-463-1840
  • Fax: 479-442-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR078610
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: