Healthcare Provider Details

I. General information

NPI: 1174779581
Provider Name (Legal Business Name): TINA M FORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA M KESSLER RN

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST SUITE C
HARRISON AR
72601-2900
US

IV. Provider business mailing address

4253 N CROSSOVER RD
FAYETTEVILLE AR
72703-4593
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-2658
  • Fax: 870-741-2722
Mailing address:
  • Phone: 479-521-5731
  • Fax: 479-521-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR42741
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: