Healthcare Provider Details

I. General information

NPI: 1598644700
Provider Name (Legal Business Name): PSYCHE NWA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 W VILLAGE PKWY STE 8
ROGERS AR
72758-8190
US

IV. Provider business mailing address

5212 W VILLAGE PKWY STE 8
ROGERS AR
72758-8190
US

V. Phone/Fax

Practice location:
  • Phone: 904-894-9260
  • Fax:
Mailing address:
  • Phone: 479-324-2671
  • Fax: 479-398-8346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CASEY JONES
Title or Position: OWNER
Credential: CRNA
Phone: 870-378-1876