Healthcare Provider Details

I. General information

NPI: 1780148262
Provider Name (Legal Business Name): JOSHUA K SANFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 HIGHWAY 412 E STE B
SILOAM SPRINGS AR
72761-8010
US

IV. Provider business mailing address

2012 S PROMENADE BLVD
ROGERS AR
72758-9073
US

V. Phone/Fax

Practice location:
  • Phone: 479-215-3080
  • Fax:
Mailing address:
  • Phone: 479-616-1485
  • Fax: 479-239-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA006065
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: