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General NPI Number Information
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NPI Number | 1396490223
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Entity Type | Organization
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Legal Business Name | CLINICALLY PROVEN HEALTHCARE
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 1905 E BEEBE CAPPS EXPY
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City | SEARCY
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State | AR
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Zip | 72143-6973
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Country | US
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Telephone | 501-278-7617
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Fax | 501-725-8813
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Provider Business Mailing Address
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Address Line | 1905 E BEEBE CAPPS EXPY
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City | SEARCY
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State | AR
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Zip | 72143-6973
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Country | US
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Telephone | 501-278-7617
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Fax | 501-725-8813
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Authorized Official
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Title or Position | CEO/APRN
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Name | MRS. SHANNON PUTMAN
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Credential | APRN
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Telephone | 501-278-9679
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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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