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General NPI Number Information
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NPI Number | 1982562427
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Entity Type | Organization
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Legal Business Name | UNITED STATES
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 209 S ELM TERRACE
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City | SEARCY
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State | AR
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Zip | 72143-6610
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Country | US
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Telephone | 870-540-9476
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Fax |
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Provider Business Mailing Address
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Address Line | 209 S ELM TERRACE
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City | SEARCY
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State | AR
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Zip | 72143-6610
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Country | US
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Telephone | 870-540-9476
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Fax |
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Authorized Official
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Title or Position | G/I DEPUTY POLICE OFFICER AT LAW
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Name | JENNIFER TAWANDA BROWN GAINES
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Credential | DR
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Telephone | 870-540-9476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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