Healthcare Provider Details

I. General information

NPI: 1992970727
Provider Name (Legal Business Name): FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST STE 4
MAMMOTH SPRING AR
72554-7423
US

IV. Provider business mailing address

350 MAIN ST STE 4
MAMMOTH SPRING AR
72554-7423
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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY D LEDBETTER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 573-651-4488