Healthcare Provider Details

I. General information

NPI: 1023285749
Provider Name (Legal Business Name): JULIE DAGGETT CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E BROADWAY ST
FORREST CITY AR
72335-3409
US

IV. Provider business mailing address

210 MANOR ST
MARION AR
72364-1936
US

V. Phone/Fax

Practice location:
  • Phone: 870-630-2328
  • Fax: 870-739-1970
Mailing address:
  • Phone: 870-739-6818
  • Fax: 870-739-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: