Healthcare Provider Details

I. General information

NPI: 1093866865
Provider Name (Legal Business Name): WICKES SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SCHOOL DR
WICKES AR
71973-9312
US

IV. Provider business mailing address

130 SCHOOL DR
WICKES AR
71973-9312
US

V. Phone/Fax

Practice location:
  • Phone: 870-385-7101
  • Fax: 870-385-2238
Mailing address:
  • Phone: 870-385-7101
  • Fax: 870-385-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN W BLACKWELL
Title or Position: SUPERINTENDENT
Credential:
Phone: 870-385-7101