Healthcare Provider Details

I. General information

NPI: 1982935177
Provider Name (Legal Business Name): ASCENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GLENDALE ST
JONESBORO AR
72401-4455
US

IV. Provider business mailing address

613 TANNEHILL DR
JONESBORO AR
72404-9033
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9528
  • Fax:
Mailing address:
  • Phone: 870-530-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number305S00000X
License Number StateAR

VIII. Authorized Official

Name: MRS. MEGAN F. NUTT
Title or Position: ECDS
Credential: BSE
Phone: 870-530-7461