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General NPI Number Information
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NPI Number | 1982037016
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Entity Type | Organization
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Legal Business Name | ASHDOWN MEDICAL CLINIC PA
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 418 N 2ND ST
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City | ASHDOWN
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State | AR
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Zip | 71822-2755
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Country | US
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Telephone | 870-898-5037
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Fax | 870-898-3910
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Provider Business Mailing Address
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Address Line | 418 N 2ND ST
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City | ASHDOWN
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State | AR
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Zip | 71822-2755
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Country | US
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Telephone | 870-898-5037
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Fax | 870-898-3910
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Authorized Official
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Title or Position | OWNER
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Name | TONI TACKETT WOMBLE
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Credential | APRN
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Telephone | 870-898-5037
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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 | A003233
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License Number State | AR
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