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General NPI Number Information
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NPI Number | 1770674491
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Entity Type | Organization
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Legal Business Name | FAULKNER HEALTH CORPORATION
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 222 SOUTH FIRST STREET
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City | ROGERS
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State | AR
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Zip | 72756-4504
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Country | US
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Telephone | 479-286-5042
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Fax | 479-464-8098
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Provider Business Mailing Address
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Address Line | 222 SOUTH FIRST STREET
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City | ROGERS
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State | AR
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Zip | 72756-4504
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Country | US
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Telephone | 479-286-5042
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Fax | 479-464-8098
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MRS. PHYLLIS A STAYTON
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Credential | R.N.
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Telephone | 417-343-5401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 002351
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License Number State | AR
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