Healthcare Provider Details

I. General information

NPI: 1245934827
Provider Name (Legal Business Name): JEDIDIAH COY WHITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MOUNTAIN PLACE DR
MOUNTAIN VIEW AR
72560-6802
US

IV. Provider business mailing address

PO BOX 707
MOUNTAIN HOME AR
72654-0707
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-3447
  • Fax: 870-269-3448
Mailing address:
  • Phone: 870-269-3447
  • Fax: 870-269-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-20187
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: