Healthcare Provider Details

I. General information

NPI: 1225528540
Provider Name (Legal Business Name): ELIZABETH FIKE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W MAIN ST
WALNUT RIDGE AR
72476-1430
US

IV. Provider business mailing address

PO BOX 839
WALNUT RIDGE AR
72476-0839
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-1200
  • Fax: 870-886-5340
Mailing address:
  • Phone: 870-886-1265
  • Fax: 870-886-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-13010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: