=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073156741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GUINN CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2019
-----------------------------------------------------
Last Update Date | 01/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1906 W HILLSBORO ST STE B
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71730-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-814-4113
-----------------------------------------------------
Fax | 501-492-6477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11898
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71730-0037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-814-4113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC, APRN-CNP/OWNER
-----------------------------------------------------
Name | MRS. CANDANCE MARIE GUINN
-----------------------------------------------------
Credential | APRN-CNP
-----------------------------------------------------
Telephone | 870-814-4113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------