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General NPI Number Information
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NPI Number | 1598644700
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Entity Type | Organization
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Legal Business Name | PSYCHE NWA LLC
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 5212 W VILLAGE PKWY STE 8
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City | ROGERS
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State | AR
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Zip | 72758-8190
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Country | US
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Telephone | 904-894-9260
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Fax |
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Provider Business Mailing Address
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Address Line | 5212 W VILLAGE PKWY STE 8
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City | ROGERS
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State | AR
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Zip | 72758-8190
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Country | US
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Telephone | 479-324-2671
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Fax | 479-398-8346
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW CASEY JONES
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Credential | CRNA
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Telephone | 870-378-1876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health 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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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