Healthcare Provider Details

I. General information

NPI: 1164356770
Provider Name (Legal Business Name): MRS. REBECCA VANWINKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SHORT ST
PANGBURN AR
72121-8836
US

IV. Provider business mailing address

1100 SHORT ST
PANGBURN AR
72121-8836
US

V. Phone/Fax

Practice location:
  • Phone: 501-728-4511
  • Fax: 501-728-2212
Mailing address:
  • Phone: 501-728-4511
  • Fax: 501-728-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR073969
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: