Healthcare Provider Details

I. General information

NPI: 1740850387
Provider Name (Legal Business Name): JIMMY LEE WOMACK JR. APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 SR 27
HECTOR AR
72843-8712
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 479-284-2127
  • Fax: 479-284-2130
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTBD
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: