MEDICARE: DR. JAMES M FUENDELING PH.D

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	103TC0700X	Clinical Psychologist	01-15P	AR
2	103G00000X	Clinical Neuropsychologist	01-15P	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5X899	OTHER	AR	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1700802485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M FUENDELING PH.D

Provider Business Mailing Address
First Line	:	2013 N GREEN ACRES RD
Second Line	:	SUITE C
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-2619
Country	:	US
Telephone Number	:	479-422-4489
Fax Number	:	479-444-6770

Provider Business Practice Location Address
First Line	:	2013 N GREEN ACRES RD
Second Line	:	SUITE C
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-2619
Country	:	US
Telephone Number	:	479-422-4489
Fax Number	:	479-444-6770

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	06/18/2015

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