Healthcare Provider Details

I. General information

NPI: 1942711064
Provider Name (Legal Business Name): AMERICAN PROHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20602 ARCH STREET PIKE
HENSLEY AR
72065-9442
US

IV. Provider business mailing address

20602 ARCH STREET PIKE
HENSLEY AR
72065-9442
US

V. Phone/Fax

Practice location:
  • Phone: 501-804-8564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANJAY DASS
Title or Position: OWNER
Credential: MD
Phone: 501-626-0053