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General NPI Number Information
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NPI Number | 1679176002
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Entity Type | Individual
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Provider Name | CORY ANDREW MCMAHON APRN
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Gender | Male
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 201 N CLIFTON ST
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City | FORDYCE
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State | AR
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Zip | 71742-3026
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Country | US
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Telephone | 870-352-6354
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Fax | 870-352-6361
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Provider Business Mailing Address
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Address Line | 200 SALVATION LN
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City | RISON
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State | AR
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Zip | 71665-9604
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Country | US
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Telephone | 870-723-1243
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Fax | 870-352-8498
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 213428
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License Number State | AR
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