MEDICARE: SQUIRREL FIELDS III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		OK

General Provider Information

NPI Number	:	1073476552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SQUIRREL FIELDS III

Provider Business Mailing Address
First Line	:	714A N 19TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3322
Country	:	US
Telephone Number	:	539-269-3027
Fax Number	:

Provider Business Practice Location Address
First Line	:	714A N 19TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3322
Country	:	US
Telephone Number	:	539-269-3027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/04/2025

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Directions to “ SQUIRREL FIELDS III ” Practice Location

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