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General NPI Number Information
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NPI Number | 1346032208
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Entity Type | Organization
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Legal Business Name | PRESTIGE CARE, PLLC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 411 W WASHINGTON AVE STE B
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City | JONESBORO
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State | AR
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Zip | 72401-2781
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Country | US
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Telephone | 870-275-4272
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Fax | 870-275-4277
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 800-824-4094
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Fax | 479-968-1673
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BENJAMIN WAGNER CARLYLE
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Credential |
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Telephone | 479-498-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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