Healthcare Provider Details

I. General information

NPI: 1013952365
Provider Name (Legal Business Name): CONNIE L HIERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/13/2007
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 Code208200000X
TaxonomyPlastic Surgery Physician
License NumberR3542
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: