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General NPI Number Information
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NPI Number | 1891186193
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Entity Type | Organization
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Legal Business Name | NICOLE M. SCALLY MD PA
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 2000 S PROMENADE BLVD SUITE 202
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City | ROGERS
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State | AR
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Zip | 72758-9073
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Country | US
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Telephone | 479-282-2737
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Fax | 479-316-4072
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Provider Business Mailing Address
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Address Line | 2000 S PROMENADE BLVD SUITE 202
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City | ROGERS
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State | AR
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Zip | 72758-9073
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Country | US
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Telephone | 479-282-2737
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Fax | 479-316-4072
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Authorized Official
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Title or Position | CHAIRMAN/PRESIDENT/SECRETARY
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Name | DR. NICOLE SCALLY
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Credential | MD
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Telephone | 479-282-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MC-3081
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License Number State | AR
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