Healthcare Provider Details

I. General information

NPI: 1023938297
Provider Name (Legal Business Name): GLOW AESTHETICS AND WEIGHT LOSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 HIGHWAY 67B N STE C
WALNUT RIDGE AR
72476-8580
US

IV. Provider business mailing address

610 HIGHWAY 67B N STE C
WALNUT RIDGE AR
72476-8580
US

V. Phone/Fax

Practice location:
  • Phone: 870-759-1025
  • Fax:
Mailing address:
  • Phone: 870-759-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER PRICE
Title or Position: OWNER
Credential: APRN, FNP-C
Phone: 870-759-1025