| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2255 Sturgis Rd, Conway, Arkansas |
| Authorized Official Name and Position | Brian P. Farley (VICE PRESIDENT & SECRETARY) |
| Authorized Official Contact | 6158616000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6100 Tower Cir Ste 1000 Franklin TN 37067-1509 Ph: (615) 861-6100 | 2255 Sturgis Rd Conway AR 72034 Ph: (501) 205-0011 |
| NPI Number | 1245728484 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 08/24/2023 |
| Certification Date | 08/24/2023 |
| Medicare PECOS PAC ID | 3779857891 |
|---|---|
| Medicare Enrollment ID | O20181010003468 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245728484 | NPI | - | NPPES |
| Provider Name | Samuel T Bayles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043331010 PECOS PAC ID: 0345333043 Enrollment ID: I20070911000987 |
| Provider Name | Leah M Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033329701 PECOS PAC ID: 5991864290 Enrollment ID: I20081031000094 |
| Provider Name | Holly N Griffis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841595386 PECOS PAC ID: 2365625126 Enrollment ID: I20110331000846 |
| Provider Name | Darren S Freeman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740442284 PECOS PAC ID: 6305021130 Enrollment ID: I20110421000089 |
| Provider Name | Thomas C Stinnett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164568598 PECOS PAC ID: 6204826621 Enrollment ID: I20120216000409 |
| Provider Name | Regina Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881120715 PECOS PAC ID: 2365712569 Enrollment ID: I20170720002316 |
| Provider Name | Kim B Dielmann |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538371190 PECOS PAC ID: 0244496230 Enrollment ID: I20190930000251 |
| Provider Name | Chastity Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588299291 PECOS PAC ID: 2961832878 Enrollment ID: I20200416002749 |
| Provider Name | Channing Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104464445 PECOS PAC ID: 4880013713 Enrollment ID: I20200928000275 |
| Provider Name | Mark D. Gage |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972544138 PECOS PAC ID: 3577552215 Enrollment ID: I20201222000095 |
| Provider Name | Que'linda Tillman-wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821661802 PECOS PAC ID: 4284031048 Enrollment ID: I20210921001679 |
| Provider Name | Faith Danielle Hendrixson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578338562 PECOS PAC ID: 7810331535 Enrollment ID: I20240221000549 |
| Provider Name | Cynthia Chow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063093102 PECOS PAC ID: 5991108151 Enrollment ID: I20241001004280 |
| Provider Name | Amber Whatley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992558191 PECOS PAC ID: 4284167214 Enrollment ID: I20241030001092 |
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