Healthcare Provider Details

I. General information

NPI: 1083978977
Provider Name (Legal Business Name): JENNIFER BINGHAM MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15785 W HIGHWAY 62 STE 1
PRAIRIE GROVE AR
72753-9201
US

IV. Provider business mailing address

15785 W HIGHWAY 62
PRAIRIE GROVE AR
72753-9201
US

V. Phone/Fax

Practice location:
  • Phone: 479-351-9476
  • Fax: 479-287-4586
Mailing address:
  • Phone: 479-351-9476
  • Fax: 479-287-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BINGHAM
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 479-351-9476