Healthcare Provider Details

I. General information

NPI: 1508040262
Provider Name (Legal Business Name): BOKKER ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 HWY 62-412
HIGHLAND AR
72542-9477
US

IV. Provider business mailing address

PO BOX 176
CHEROKEE VILLAGE AR
72525-0176
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-3337
  • Fax: 870-856-3334
Mailing address:
  • Phone: 870-856-3337
  • Fax: 870-856-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LON PAUL BOKKER
Title or Position: CEO
Credential: PHD
Phone: 870-856-3337