Basic Information
| Provider Information | |||||||||
| NPI: | 1982935177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 613 TANNEHILL DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724049033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705307461 | ||||||||
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| Practice Location | |||||||||
| Address1: | 806 GLENDALE ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709339528 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | NUTT | ||||||||
| AuthorizedOfficialFirstName: | MEGAN | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | ECDS | ||||||||
| AuthorizedOfficialTelephone: | 8705307461 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BSE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | 305S00000X | AR | Y | Managed Care Organizations | Point of Service |
No ID Information.