Healthcare Provider Details

I. General information

NPI: 1730425448
Provider Name (Legal Business Name): FACE 2 FACE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 SYLVAN HILLS RD
VAN BUREN AR
72956-2565
US

IV. Provider business mailing address

PO BOX 140
LAVACA AR
72941-0140
US

V. Phone/Fax

Practice location:
  • Phone: 479-208-3471
  • Fax: 888-987-1841
Mailing address:
  • Phone: 479-674-9181
  • Fax: 479-674-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN RENE BRONISTE
Title or Position: OWNER
Credential: APN
Phone: 479-208-3471