Healthcare Provider Details

I. General information

NPI: 1477496420
Provider Name (Legal Business Name): SOLOMON OBINNA JEPHTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S E ST
FORT SMITH AR
72901-4716
US

IV. Provider business mailing address

1301 S E ST
FORT SMITH AR
72901-4716
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-2431
  • Fax: 479-494-7787
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: