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General NPI Number Information
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NPI Number | 1538485941
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Entity Type | Individual
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Provider Name | DAVID LUKE BRIGHTWELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 54 TATE SPRINGS RD
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City | MELBOURNE
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State | AR
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Zip | 72556-8633
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Country | US
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Telephone | 870-368-5030
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Fax | 870-368-5032
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Provider Business Mailing Address
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Address Line | 117 S 2ND ST PO BOX 497
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City | AUGUSTA
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State | AR
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Zip | 72006-2309
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Country | US
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Telephone | 870-347-2534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-407
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License Number State | AR
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