Healthcare Provider Details

I. General information

NPI: 1558673285
Provider Name (Legal Business Name): JOY ANN COONFIELD LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14195 STRAWBERRY RIDGE ROAD
GRAVETTE AR
72736
US

IV. Provider business mailing address

PO BOX 394
GRAVETTE AR
72736-0394
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5065
  • Fax:
Mailing address:
  • Phone: 479-787-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number032009
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: