Healthcare Provider Details

I. General information

NPI: 1275376063
Provider Name (Legal Business Name): ASHENIX ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 FOX RD STE D
JONESBORO AR
72404-9577
US

IV. Provider business mailing address

3114 FOX RD STE D
JONESBORO AR
72404-9577
US

V. Phone/Fax

Practice location:
  • Phone: 870-322-6056
  • Fax:
Mailing address:
  • Phone: 870-322-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLYN FRACHISEUR
Title or Position: OWNER
Credential:
Phone: 870-613-2520