=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760842868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN AUSTIN SOMMER PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2016
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 HOPSITAL DR - EMERGENCY DEPT
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72653-2955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-508-1000
-----------------------------------------------------
Fax | 870-424-5859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1269
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72654-1269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-425-6322
-----------------------------------------------------
Fax | 870-424-5859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 7896
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA-130
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------