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General NPI Number Information
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NPI Number | 1346848850
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Entity Type | Organization
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Legal Business Name | ARKANSAS PREMIER MEDICAL CLINIC
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 22461 I 30 STE 402
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City | BRYANT
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State | AR
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Zip | 72022-2383
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Country | US
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Telephone | 501-303-8289
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Fax |
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Provider Business Mailing Address
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Address Line | 8524 HART RD
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City | BENTON
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State | AR
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Zip | 72019-7186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | APN/PART OWNER
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Name | MRS. ANNA KATHERINE ROAS
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Credential | APN
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Telephone | 501-303-8289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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