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General NPI Number Information
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NPI Number | 1154143675
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Entity Type | Organization
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Legal Business Name | BREAKING CHAINS MENTAL HEALTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1017 BROWNSTONE DR
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City | JONESBORO
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State | AR
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Zip | 72404-8796
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Country | US
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Telephone | 870-926-3463
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 BROWNSTONE DR
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City | JONESBORO
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State | AR
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Zip | 72404-8796
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Country | US
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Telephone | 870-926-3463
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Fax |
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Authorized Official
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Title or Position | ADVANCED PRACTICE REGISTERED NURSE
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Name | TAMMY RENEE HAWKINS
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Credential |
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Telephone | 870-926-3463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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