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General NPI Number Information
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NPI Number | 1295463867
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Entity Type | Organization
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Legal Business Name | YOUTHFUL YOU AESTHETICS, PLLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 277 MAIN ST
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City | MAMMOTH SPRING
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State | AR
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Zip | 72554
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Country | US
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Telephone | 417-293-6549
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Fax |
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Provider Business Mailing Address
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Address Line | 277 MAIN ST
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City | MAMMOTH SPRING
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State | AR
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Zip | 72554
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Country | US
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Telephone | 417-293-6549
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SONYA LEIGH TURNER
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Credential |
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Telephone | 417-293-6549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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