Healthcare Provider Details

I. General information

NPI: 1477341469
Provider Name (Legal Business Name): IMAGE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-1868
US

IV. Provider business mailing address

2629 N SIERRA AVE
FAYETTEVILLE AR
72703-3370
US

V. Phone/Fax

Practice location:
  • Phone: 479-800-0011
  • Fax:
Mailing address:
  • Phone: 479-800-0011
  • Fax: 877-693-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER E OXFORD
Title or Position: OWNER
Credential: APRN
Phone: 479-236-2108