Healthcare Provider Details

I. General information

NPI: 1720482482
Provider Name (Legal Business Name): OZARK WELLNESS CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W COLLEGE ST
OZARK AR
72949-2850
US

IV. Provider business mailing address

102 W COLLEGE ST
OZARK AR
72949-2850
US

V. Phone/Fax

Practice location:
  • Phone: 479-667-2222
  • Fax: 479-667-2252
Mailing address:
  • Phone: 479-667-2222
  • Fax: 479-667-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number5001039
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5001039
License Number StateAR

VIII. Authorized Official

Name: YVONIA JEAN FINLEY
Title or Position: PRESIDENT
Credential: APRN CNS
Phone: 479-667-2222