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General NPI Number Information
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NPI Number | 1417480161
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Entity Type | Organization
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Legal Business Name | OZARK GERIATRICS OF HARRISON LLC
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 6166 HIGHWAY 206 W
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City | HARRISON
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State | AR
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Zip | 72601-9235
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Country | US
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Telephone | 870-365-2829
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Fax | 870-741-2763
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Provider Business Mailing Address
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Address Line | 6166 HIGHWAY 206 W
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City | HARRISON
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State | AR
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Zip | 72601-9235
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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 | OWNER
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Name | AMANDA CHITSEY
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Credential |
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Telephone | 870-365-7441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | A01409
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License Number State | AR
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