Healthcare Provider Details

I. General information

NPI: 1184951998
Provider Name (Legal Business Name): DONNA BEALLIS D.O. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E MONTE PAINTER DR
FAYETTEVILLE AR
72703-4002
US

IV. Provider business mailing address

PO BOX 11134
FORT SMITH AR
72917-1134
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-2200
  • Fax: 479-444-2390
Mailing address:
  • Phone: 479-285-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberE-5626
License Number StateAR

VIII. Authorized Official

Name: MS. DONNA B BEALLIS
Title or Position: OWNER
Credential: D.O.
Phone: 479-806-0647