Healthcare Provider Details

I. General information

NPI: 1104282664
Provider Name (Legal Business Name): HOWARD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MEDICAL CIR
NASHVILLE AR
71852-8606
US

IV. Provider business mailing address

130 MEDICAL CIR
NASHVILLE AR
71852-8606
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-6069
  • Fax: 845-845-6068
Mailing address:
  • Phone: 870-845-8024
  • Fax: 870-845-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberE-5611
License Number StateAR

VIII. Authorized Official

Name: MRS. JUDY ANN KOSTERS
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 870-845-8024