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General NPI Number Information
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NPI Number | 1225289978
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Entity Type | Organization
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Legal Business Name | OUACHITA FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 1210 DEQUEEN ST
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City | MENA
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State | AR
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Zip | 71953-4132
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Country | US
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Telephone | 479-394-5068
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Fax | 479-394-5626
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Provider Business Mailing Address
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Address Line | PO BOX 1788
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City | MENA
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State | AR
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Zip | 71953-1781
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Country | US
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Telephone | 479-394-5068
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DEBBIE KINCAID
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Credential |
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Telephone | 479-394-5068
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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 | A03080ANP
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N6236
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A01300-ANP
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License Number State | AR
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