| NPI | 1083325757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD HENRY Enrollment Manager 479-258-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2022-12-13 |