|
| |
|
2707 Se G St Bentonville AR 72712-3740 | |
| (147) 936-7255 | |
| (479) 367-2584 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2707 Se G St, Bentonville, Arkansas |
| Authorized Official Name and Position | Randy H Jenkins (OFFICE MANAGER) |
| Authorized Official Contact | 4793672552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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: (147) 936-7255 |
| NPI Number | 1205001088 |
|---|---|
| Provider Enumeration Date | 04/23/2008 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Medicare PECOS PAC ID | 9234114349 |
|---|---|
| Medicare Enrollment ID | O20040622001640 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205001088 | NPI | - | NPPES |
| 1891880373 | Medicaid | MO | |
| 118344001 | Medicaid | AR | |
| 100080220A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Wanda L Rodinsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720112725 PECOS PAC ID: 8426120973 Enrollment ID: I20080628000164 |
| Provider Name | Christine A Sinclair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457642688 PECOS PAC ID: 1850579921 Enrollment ID: I20110621000441 |
| Provider Name | Donnie Joe Holden |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891880373 PECOS PAC ID: 8224013339 Enrollment ID: I20120201000780 |
| Provider Name | Lindsey Goucher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780348474 PECOS PAC ID: 4183014582 Enrollment ID: I20211129000784 |
| Provider Name | Eli Jacob Fulfer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629848098 PECOS PAC ID: 2365973526 Enrollment ID: I20240930002131 |
Katherine C Shook, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 307 Sw 18th St Ste 3, Bentonville, AR 72712 Phone: 479-721-1788 | |
Fleuri, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2700 Se Otis Corley Dr Ste 14, Bentonville, AR 72712 Phone: 318-245-3437 | |
Emerge Therapy Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2713 Se I St Ste 5, Bentonville, AR 72712 Phone: 479-250-4355 Fax: 479-553-7954 | |
Jennifer Burleson Lcsw, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1116 S Walton Blvd Ste 114, Bentonville, AR 72712 Phone: 917-405-5514 | |
Wh Nj Medical Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 702 Sw 8th St # Ms 0215, Bentonville, AR 72716 Phone: 479-258-2080 | |
Wh Ks Medical Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 702 Sw 8th Street, Mail Stop 0445, Bentonville, AR 72716 Phone: 479-360-0304 | |
Aaron Mclellan, Lpc Counseling Services, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2700 Se Otis Corley Dr Ste 14, Bentonville, AR 72712 Phone: 479-234-9129 |