Healthcare Provider Details

I. General information

NPI: 1912853896
Provider Name (Legal Business Name): CCMOUN HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SOUTH ST # 100
MOUNTAIN HOME AR
72653-4452
US

IV. Provider business mailing address

5904 SW COYWOLF ST
BENTONVILLE AR
72713-3324
US

V. Phone/Fax

Practice location:
  • Phone: 509-768-2249
  • Fax: 248-780-3452
Mailing address:
  • Phone:
  • Fax: 248-780-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. UZOMA MELISSA OBI-NWANKWO
Title or Position: MANAGER
Credential:
Phone: 936-333-8090