Healthcare Provider Details

I. General information

NPI: 1114865151
Provider Name (Legal Business Name): SOUTHERN ARKANSAS WOUND AND FOOT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 SMACKOVER HWY
SMACKOVER AR
71762-9533
US

IV. Provider business mailing address

4450 SMACKOVER HWY
SMACKOVER AR
71762-9533
US

V. Phone/Fax

Practice location:
  • Phone: 870-814-0018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THOMAS C HEAD
Title or Position: OWNER
Credential: APRN-CNP
Phone: 870-814-0018