Healthcare Provider Details

I. General information

NPI: 1396809711
Provider Name (Legal Business Name): PLASTIC SURGERY ASSOCIATES OF NORTHEAST ARKANSAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WINDOVER RD
JONESBORO AR
72401-6007
US

IV. Provider business mailing address

1003 WINDOVER RD
JONESBORO AR
72401-6007
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-0861
  • Fax: 870-972-5241
Mailing address:
  • Phone: 870-935-0861
  • Fax: 870-972-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR3542
License Number StateAR

VIII. Authorized Official

Name: DR. CONNIE L. HIERS
Title or Position: OWNER
Credential: M.D.
Phone: 870-935-0861