Healthcare Provider Details

I. General information

NPI: 1619820701
Provider Name (Legal Business Name): NEW YORK INSTITUTE OF TECHNOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 SAINT FRANCIS ST
MARKED TREE AR
72365-2241
US

IV. Provider business mailing address

PO BOX 1380
STATE UNIVERSITY AR
72467-1380
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-2054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANE SPEIGHTS
Title or Position: DEAN OF NYITCOM-AR
Credential: DO
Phone: 870-680-8882