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General NPI Number Information
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NPI Number | 1518957240
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE ASSOCIATES OF CLARKSVILLE,PA
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 23 PROFESSIONAL PARK DR
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City | CLARKSVILLE
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State | AR
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Zip | 72830-4432
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Country | US
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Telephone | 479-754-4721
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Fax | 844-584-4213
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Provider Business Mailing Address
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Address Line | 23 PROFESSIONAL PARK DR
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City | CLARKSVILLE
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State | AR
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Zip | 72830-4432
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Country | US
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Telephone | 479-754-4721
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Fax | 844-584-4213
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DARLENE PRATT
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Credential |
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Telephone | 479-754-4721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MC-1606
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License Number State | AR
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