Healthcare Provider Details

I. General information

NPI: 1467055707
Provider Name (Legal Business Name): HEALTHY ARKANSAS FAMILY PRACTICE & URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N HIGHWAY 365
REDFIELD AR
72132-9209
US

IV. Provider business mailing address

1500 N HIGHWAY 365
REDFIELD AR
72132-9209
US

V. Phone/Fax

Practice location:
  • Phone: 870-200-3212
  • Fax: 501-200-3213
Mailing address:
  • Phone: 870-200-3212
  • Fax: 501-200-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWN GASAWAY
Title or Position: APRN
Credential: FNP
Phone: 501-200-3212