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General NPI Number Information
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NPI Number | 1457226706
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Entity Type | Organization
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Legal Business Name | HUNTSVILLE MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 705 PHILLIPS PL PO BOX 860
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City | HUNTSVILLE
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State | AR
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Zip | 72740
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Country | US
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Telephone | 479-738-1700
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Fax | 479-738-5510
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Provider Business Mailing Address
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Address Line | PO BOX 860
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City | HUNTSVILLE
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State | AR
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Zip | 72740-0860
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Country | US
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Telephone | 479-738-1700
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Fax | 479-738-5510
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Authorized Official
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Title or Position | MANAGER
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Name | GINA DICKEY
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Credential | APRN
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Telephone | 479-738-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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