Healthcare Provider Details

I. General information

NPI: 1578909362
Provider Name (Legal Business Name): DYSON PSYCHIACTRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E MATTHEWS AVE
JONESBORO AR
72401-3048
US

IV. Provider business mailing address

PO BOX 17253
JONESBORO AR
72403-6723
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-1497
  • Fax: 866-422-5771
Mailing address:
  • Phone: 870-972-1497
  • Fax: 866-422-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberE-5305
License Number StateAR

VIII. Authorized Official

Name: MRS. CORI ANNE DYSON
Title or Position: OWNER
Credential: M.D
Phone: 870-972-1497