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General NPI Number Information
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NPI Number | 1104300854
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Entity Type | Organization
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Legal Business Name | WILLOW PAIN AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 255 MEDICAL CENTER DR.
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City | BATESVILLE
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State | MS
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Zip | 38606
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Country | US
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Telephone | 662-638-0462
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Fax | 866-658-0083
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Provider Business Mailing Address
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Address Line | PO BOX 2730
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City | OXFORD
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State | MS
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Zip | 38655-4200
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Country | US
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Telephone | 662-638-0462
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Fax | 866-658-0083
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Authorized Official
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Title or Position | OWNER/ MEDICAL DIRECTOR
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Name | KIRK L. KINARD
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Credential | DO
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Telephone | 662-638-0462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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