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General NPI Number Information
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NPI Number | 1063871044
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Entity Type | Organization
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Legal Business Name | OPEN DOOR HEALTH AND COMMUNITY SERVICES
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 425 N CENTENNIAL AVE SUITE A
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City | WEST FORK
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State | AR
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Zip | 72774-2708
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Country | US
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Telephone | 479-294-6151
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Fax | 479-294-6152
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Provider Business Mailing Address
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Address Line | 425 N CENTENNIAL AVE SUITE A
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City | WEST FORK
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State | AR
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Zip | 72774-2708
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Country | US
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Telephone | 479-294-6151
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Fax | 479-294-6152
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | LELA R SHIPMAN
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Credential | APRN
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Telephone | 479-294-6151
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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 | A001150
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License Number State | AR
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