Healthcare Provider Details

I. General information

NPI: 1992806376
Provider Name (Legal Business Name): FAMILY HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S MAIN ST STE 4
MAMMOTH SPRING AR
72554-7425
US

IV. Provider business mailing address

350 MAIN ST STE 4
MAMMOTH SPRING AR
72554-7425
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-3111
  • Fax: 870-625-3118
Mailing address:
  • Phone: 870-625-3111
  • Fax: 870-625-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAO2947
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY P WARD
Title or Position: OWNER
Credential: FNP
Phone: 870-625-3111