Healthcare Provider Details

I. General information

NPI: 1295463867
Provider Name (Legal Business Name): YOUTHFUL YOU AESTHETICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 MAIN ST
MAMMOTH SPRING AR
72554
US

IV. Provider business mailing address

277 MAIN ST
MAMMOTH SPRING AR
72554
US

V. Phone/Fax

Practice location:
  • Phone: 417-293-6549
  • Fax:
Mailing address:
  • Phone: 417-293-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONYA LEIGH TURNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-293-6549