Healthcare Provider Details

I. General information

NPI: 1588809792
Provider Name (Legal Business Name): NORTHEAST ARKANSAS CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 WINDOVER RD
JONESBORO AR
72401-6038
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-4145
  • Fax: 870-336-4148
Mailing address:
  • Phone: 870-934-5140
  • Fax: 870-932-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL KING
Title or Position: COO
Credential:
Phone: 870-934-5140