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General NPI Number Information
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NPI Number | 1932087210
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Entity Type | Organization
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Legal Business Name | SKINNY FOX WEIGHT LOSS & MEDICAL CLINIC, LLC.
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 422 BEECH ST
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City | TEXARKANA
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State | AR
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Zip | 71854-5310
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Country | US
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Telephone | 870-773-1111
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Fax | 870-772-1354
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Provider Business Mailing Address
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Address Line | 422 BEECH ST
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City | TEXARKANA
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State | AR
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Zip | 71854-5310
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Country | US
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Telephone | 870-773-1111
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Fax | 870-772-1354
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | LISA DIANN HART
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Credential | FNP-C
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Telephone | 870-773-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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