Healthcare Provider Details

I. General information

NPI: 1609063502
Provider Name (Legal Business Name): ANGELA MCCORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA CLAY

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 DOGWOOD HOLLOW RD
MOUNTAIN VIEW AR
72560-7942
US

IV. Provider business mailing address

PO BOX 1589
BENTON AR
72018-1589
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-7732
  • Fax:
Mailing address:
  • Phone: 501-315-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12910-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: