Healthcare Provider Details

I. General information

NPI: 1659340297
Provider Name (Legal Business Name): NE ARKANSAS OTOLARYNGOLOGY FACIAL SURGERY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E MATTHEWS AVE
JONESBORO AR
72401-3145
US

IV. Provider business mailing address

621 E MATTHEWS AVE
JONESBORO AR
72401-3145
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-6799
  • Fax: 870-932-8423
Mailing address:
  • Phone: 870-932-6799
  • Fax: 870-932-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSIE YOUNG
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-932-6799