Healthcare Provider Details

I. General information

NPI: 1700236031
Provider Name (Legal Business Name): VONDA HARNESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 HIGHWAY 65 N
MARSHALL AR
72650-7863
US

IV. Provider business mailing address

602 N WALTON BLVD
BENTONVILLE AR
72712-4576
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-4727
  • Fax: 870-448-4496
Mailing address:
  • Phone: 479-464-1060
  • Fax: 479-271-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: