Healthcare Provider Details

I. General information

NPI: 1619296407
Provider Name (Legal Business Name): ANDREA NICHOLE BOUNDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BURNETT DR
MOUNTAIN HOME AR
72653-2941
US

IV. Provider business mailing address

630 BURNETT DR
MOUNTAIN HOME AR
72653-2941
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-6971
  • Fax: 870-508-8900
Mailing address:
  • Phone: 870-425-6971
  • Fax: 870-508-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE7518
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE7518
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: