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General NPI Number Information
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NPI Number | 1003215955
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Entity Type | Organization
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Legal Business Name | CLEAR SKIN MEDICAL SOLUTIONS, LLC
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Dates
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Enumeration Date | 08/16/2014
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Last Update Date | 08/16/2014
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Provider Practice Location Address
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Address Line | 715 W SHERMAN AVE SUITE H
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City | HARRISON
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State | AR
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Zip | 72601-2743
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Country | US
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Telephone | 870-204-5346
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Fax | 870-365-0481
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Provider Business Mailing Address
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Address Line | PO BOX 1102
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City | HARRISON
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State | AR
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Zip | 72602-1102
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Country | US
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Telephone | 870-204-5346
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Fax | 870-365-0481
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Authorized Official
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Title or Position | MGR/MEMBER
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Name | PAMELA ROBIN GRIFFIN
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Credential | APRN
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Telephone | 870-204-5346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A001877
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License Number State | AR
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