Basic Information
| Provider Information | |||||||||
| NPI: | 1780857284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TWOMBLY | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | DUANE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 628 HOSPITAL DR STE E | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198723201 | ||||||||
| FaxNumber: | 4198723208 | ||||||||
| Practice Location | |||||||||
| Address1: | 628 HOSPITAL DR STE E | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726532953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198723201 | ||||||||
| FaxNumber: | 4198723208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2008 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34-009177 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 06-1833974 | AR | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 267325YJL4 | 01 | AR | MEDICARE PTAN | OTHER | 197028003 | 05 | AR | MEDICAID |