Healthcare Provider Details

I. General information

NPI: 1275812620
Provider Name (Legal Business Name): MISSISSIPPI COUNTY CHILD DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 09/28/2011
Certification Date: MISSISSIPPI COUNTY CHILD DEVELOPMENT CENTER 315 E UNION AVE OSCEOLA AR 72370 315 E UNION AVE OSCEOLA AR 72370
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E UNION AVE
OSCEOLA AR
72370-3235
US

IV. Provider business mailing address

315 E UNION AVE
OSCEOLA AR
72370-3235
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-1331
  • Fax: 870-563-1334
Mailing address:
  • Phone: 870-563-1331
  • Fax: 870-563-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA KAY WYNNE
Title or Position: ADMINISTRATIVE
Credential:
Phone: 870-563-1331