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General NPI Number Information
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NPI Number | 1629700281
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Entity Type | Organization
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Legal Business Name | K GRIFFITH PMHNP LLC
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 1 W SUNBRIDGE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1825
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Country | US
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Telephone | 479-443-5575
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Fax | 479-443-9554
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Provider Business Mailing Address
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Address Line | 610 KITTY HAWK ST
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City | VAN BUREN
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State | AR
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Zip | 72956-2132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLEY DANIELLE GRIFFITH
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Credential | APRN
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Telephone | 479-312-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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