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General NPI Number Information
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NPI Number | 1578819405
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Entity Type | Individual
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Provider Name | MONICA M BOMAR PA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | PO BOX 456
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City | BALD KNOB
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State | AR
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Zip | 72010-0456
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Country | US
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Telephone | 501-724-6207
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Fax | 501-724-3305
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Provider Business Mailing Address
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Address Line | 117 S 2ND ST
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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 | 870-347-5556
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | P-T1224
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-484
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License Number State | AR
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