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2707 Se G St Bentonville AR 72712-3740 | |
| (479) 367-2552 | |
| (479) 367-2584 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 2707 Se G St, Bentonville, Arkansas |
| Authorized Official Name and Position | Randy Harrison Jenkins (OFFICE MANAGER) |
| Authorized Official Contact | 4793672552 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2707 Se G St Bentonville AR 72712-3740 Ph: (479) 367-2552 | 2707 Se G St Bentonville AR 72712-3740 Ph: (479) 367-2552 |
| NPI Number | 1891230835 |
|---|---|
| Provider Enumeration Date | 12/29/2016 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891230835 | NPI | - | NPPES |
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