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General NPI Number Information
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NPI Number | 1376221622
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Entity Type | Organization
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Legal Business Name | VITALITY AESTHETICS
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 3810 CENTRAL AVE STE D
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6921
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Country | US
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Telephone | 501-353-5613
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Fax |
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Provider Business Mailing Address
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Address Line | 118 TATUM ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-9361
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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 | CO-OWNER
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Name | MRS. TIFFANY MCCONATHY
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Credential | APRN
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Telephone | 501-627-5788
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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 | 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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