Basic Information
| Provider Information | |||||||||
| NPI: | 1295104578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCEL HEALTH OF HASKELL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6029 HIGHWAY 67 | ||||||||
| Address2: | |||||||||
| City: | HASKELL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720158400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017946808 | ||||||||
| FaxNumber: | 8842721481 | ||||||||
| Practice Location | |||||||||
| Address1: | 6029 US HWY 67 | ||||||||
| Address2: | |||||||||
| City: | HASKELL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018473292 | ||||||||
| FaxNumber: | 5012130573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2015 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5012232776 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |
No ID Information.