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NPI Code Detail

MEDICARE: SANDRA K WOMACK

MEDICARE: SANDRA K WOMACK
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1629256425
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA K WOMACK
Provider Business Mailing Address
First Line : PO BOX 251970
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72225-1970
Country : US
Telephone Number : 501-666-8686
Fax Number : 501-660-6830
Provider Business Practice Location Address
First Line : 1020 W DAISY L GATSON BATES DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72202-5402
Country : US
Telephone Number : 501-666-4949
Fax Number : 501-660-6840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2008
Last Update Date : 02/04/2008

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Directions to “ SANDRA K WOMACK ” Practice Location

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