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General NPI Number Information
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NPI Number | 1396809711
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY ASSOCIATES OF NORTHEAST ARKANSAS, P.A.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 1003 WINDOVER RD
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City | JONESBORO
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State | AR
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Zip | 72401-6007
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Country | US
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Telephone | 870-935-0861
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Fax | 870-972-5241
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Provider Business Mailing Address
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Address Line | 1003 WINDOVER RD
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City | JONESBORO
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State | AR
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Zip | 72401-6007
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Country | US
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Telephone | 870-935-0861
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Fax | 870-972-5241
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Authorized Official
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Title or Position | OWNER
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Name | DR. CONNIE L. HIERS
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Credential | M.D.
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Telephone | 870-935-0861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R3542
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License Number State | AR
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