=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508639352
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON DOUGAN-MOLPUS ND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2023
-----------------------------------------------------
Last Update Date | 11/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 ZONE RIDGE LN
-----------------------------------------------------
City | YELLVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72687-7040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-253-2435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 ZONE RIDGE LN
-----------------------------------------------------
City | YELLVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72687-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-253-2435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------