Healthcare Provider Details

I. General information

NPI: 1720414451
Provider Name (Legal Business Name): BEAN TOTS AND TODDLERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 STONE ST
JONESBORO AR
72401-4519
US

IV. Provider business mailing address

1220 STONE ST
JONESBORO AR
72401-4519
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-1989
  • Fax: 870-268-6705
Mailing address:
  • Phone: 870-933-1989
  • Fax: 870-268-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: PATRICK BEAN
Title or Position: OWNER
Credential:
Phone: 870-933-1989