Healthcare Provider Details

I. General information

NPI: 1013871714
Provider Name (Legal Business Name): PRIMARY CARE COLLECTIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 ROBERTS BLVD
FORT SMITH AR
72916-6027
US

IV. Provider business mailing address

11300 ROBERTS BLVD
FORT SMITH AR
72916-6027
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-5910
  • Fax: 479-668-0169
Mailing address:
  • Phone: 479-242-5910
  • Fax: 479-668-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DELLI RAE TYLER
Title or Position: PHYSICIAN
Credential: DO
Phone: 479-883-0917