Healthcare Provider Details

I. General information

NPI: 1710336185
Provider Name (Legal Business Name): LYNNETTE DARRACQ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N CARDINAL DR STE 7
MOUNTAIN HOME AR
72653-3274
US

IV. Provider business mailing address

71 MANDARIN CT
MOUNTAIN HOME AR
72653-5414
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-5644
  • Fax: 870-424-2201
Mailing address:
  • Phone: 870-405-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: