Healthcare Provider Details

I. General information

NPI: 1922532837
Provider Name (Legal Business Name): NURSE PRACTITIONERS FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9798 HIGHWAY 62 WEST
VIOLA AR
72583
US

IV. Provider business mailing address

9798 HIGHWAY 62 WEST
VIOLA AR
72583
US

V. Phone/Fax

Practice location:
  • Phone: 870-458-6732
  • Fax:
Mailing address:
  • Phone: 870-458-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA004928
License Number StateAR

VIII. Authorized Official

Name: MRS. DARLA ANN JOHNSTON
Title or Position: OWNER
Credential: APRN, FNP-C
Phone: 870-458-3187