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General NPI Number Information
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NPI Number | 1396483673
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Entity Type | Organization
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Legal Business Name | TONYMON NEURO SPINE CLINIC, PLLC
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 2900 MEDICAL CENTER PKWY STE 220
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City | BENTONVILLE
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State | AR
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Zip | 72712-3213
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Country | US
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Telephone | 479-696-0996
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8490
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0009
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Country | US
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Telephone | 870-926-5010
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. KENNETH TONYMON
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Credential | MD
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Telephone | 870-926-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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