Healthcare Provider Details

I. General information

NPI: 1265225502
Provider Name (Legal Business Name): MIDSOUTH WOUND CARE OF ARKANSAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 TRINITY HTS
TEXARKANA AR
71854-8318
US

IV. Provider business mailing address

5904 SUMMERFIELD DR
TEXARKANA TX
75503-4306
US

V. Phone/Fax

Practice location:
  • Phone: 501-621-2770
  • Fax:
Mailing address:
  • Phone: 501-621-2770
  • Fax:

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 Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. VERNON DEAN BOWMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 501-621-2770