Healthcare Provider Details

I. General information

NPI: 1962882902
Provider Name (Legal Business Name): TIFFANY BRUMLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MEDICAL CENTER DR
POCAHONTAS AR
72455-9438
US

IV. Provider business mailing address

2901 MEDICAL CENTER DR
POCAHONTAS AR
72455-9438
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-4467
  • Fax: 870-892-4407
Mailing address:
  • Phone: 870-892-4467
  • Fax: 870-892-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004419
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: