Basic Information
Provider Information | |||||||||
NPI: | 1720482482 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OZARK WELLNESS CLINIC PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 102 W COLLEGE ST | ||||||||
Address2: |   | ||||||||
City: | OZARK | ||||||||
State: | AR | ||||||||
PostalCode: | 729492850 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4796672222 | ||||||||
FaxNumber: | 4796672252 | ||||||||
Practice Location | |||||||||
Address1: | 102 W COLLEGE ST | ||||||||
Address2: |   | ||||||||
City: | OZARK | ||||||||
State: | AR | ||||||||
PostalCode: | 729492850 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4796672222 | ||||||||
FaxNumber: | 4796672252 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/09/2014 | ||||||||
LastUpdateDate: | 01/19/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FINLEY | ||||||||
AuthorizedOfficialFirstName: | YVONIA | ||||||||
AuthorizedOfficialMiddleName: | JEAN | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4796672222 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | APRN CNS | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | 5001039 | AR | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 363LF0000X | 5001039 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.