Healthcare Provider Details

I. General information

NPI: 1114277993
Provider Name (Legal Business Name): RUSSELL B ALLISON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 W ASH ST
POTTSVILLE AR
72858-9170
US

IV. Provider business mailing address

PO BOX 1146
RUSSELLVILLE AR
72811-1146
US

V. Phone/Fax

Practice location:
  • Phone: 479-880-1118
  • Fax: 479-880-1120
Mailing address:
  • Phone: 479-890-9292
  • Fax: 479-890-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01298 ANP
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROL TOWNSEND
Title or Position: NURSE PRACITIONER
Credential: NPA
Phone: 479-880-1118