Healthcare Provider Details

I. General information

NPI: 1346430188
Provider Name (Legal Business Name): MICHELLE LYN WINSLOW RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLLEGE ST SUITE 2
MOUNTAIN HOME AR
72653-3923
US

IV. Provider business mailing address

8 MEDICAL PLZ
MOUNTAIN HOME AR
72653-2919
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-4551
  • Fax: 870-508-2644
Mailing address:
  • Phone: 870-425-6901
  • Fax: 870-424-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR72023
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAO1823
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: