Healthcare Provider Details

I. General information

NPI: 1427631589
Provider Name (Legal Business Name): PALLIATIVE HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S WALDRON RD STE 208
FORT SMITH AR
72903-2565
US

IV. Provider business mailing address

PO BOX 12883
OKLAHOMA CITY OK
73157-2883
US

V. Phone/Fax

Practice location:
  • Phone: 914-325-2103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSIELA ROBERTS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 479-401-2123