Healthcare Provider Details

I. General information

NPI: 1225468747
Provider Name (Legal Business Name): HOPE FAMILY CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 20TH ST
HOPE AR
71801-8213
US

IV. Provider business mailing address

PO BOX 295
LOCKESBURG AR
71846-0295
US

V. Phone/Fax

Practice location:
  • Phone: 870-289-5865
  • Fax:
Mailing address:
  • Phone: 870-289-5865
  • Fax: 870-289-6993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003958
License Number StateAR

VIII. Authorized Official

Name: TONY ASBILLE
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 903-748-9729