| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1440 W 1st N, Prescott, Arkansas |
| Authorized Official Name and Position | Mary E Dwight (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 9036143282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5002 Cowhorn Creek Rd Texarkana TX 75503-9766 Ph: (903) 614-3000 | 1440 W 1st N Prescott AR 71853 Ph: (870) 887-8001 |
| NPI Number | 1740262732 |
|---|---|
| Provider Enumeration Date | 11/16/2005 |
| Last Update Date | 02/24/2023 |
| Medicare PECOS PAC ID | 1355249541 |
|---|---|
| Medicare Enrollment ID | O20040721000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740262732 | NPI | - | NPPES |
| 149724002 | Medicaid | AR | |
| CC9231 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Texas) | Primary |
| Provider Name | Thomas Alan Fox |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770583189 PECOS PAC ID: 9436042769 Enrollment ID: I20040202001158 |
| Provider Name | Paul Gardial |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639170194 PECOS PAC ID: 6608850631 Enrollment ID: I20040616000821 |
| Provider Name | Edward W Tobey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306846712 PECOS PAC ID: 6608855846 Enrollment ID: I20040720000416 |
| Provider Name | Jason Zhi Lee |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1285634592 PECOS PAC ID: 6204806292 Enrollment ID: I20040728000186 |
| Provider Name | Hayden Nix Hemphill |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1396746376 PECOS PAC ID: 2668420159 Enrollment ID: I20050111000935 |
| Provider Name | Christopher Payne |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1558363507 PECOS PAC ID: 0345297628 Enrollment ID: I20050601000651 |
| Provider Name | John Owen Stevens |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1508886482 PECOS PAC ID: 4385799501 Enrollment ID: I20120130000062 |
| Provider Name | Timothy Adam Crabtree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487927711 PECOS PAC ID: 1355505710 Enrollment ID: I20120827000595 |
| Provider Name | Katherine Antoinette Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407203425 PECOS PAC ID: 3274824347 Enrollment ID: I20160621000084 |
| Provider Name | Robert James Leach |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1114910411 PECOS PAC ID: 1658352893 Enrollment ID: I20180122000808 |
| Provider Name | Kevin Henderson O'sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922492859 PECOS PAC ID: 6507174737 Enrollment ID: I20180822000663 |
| Provider Name | Muazer Bushra Mohamed Ahmed |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1891113577 PECOS PAC ID: 2466673066 Enrollment ID: I20190828002198 |
| Provider Name | John Stanley Griffin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720088636 PECOS PAC ID: 2163561820 Enrollment ID: I20200408003182 |
| Provider Name | Blane A Graves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124010301 PECOS PAC ID: 3971652199 Enrollment ID: I20200413001530 |
| Provider Name | Jamie L Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538609920 PECOS PAC ID: 1850677766 Enrollment ID: I20211026003648 |
| Provider Name | Kayla Nicole Stockton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023732716 PECOS PAC ID: 9032585153 Enrollment ID: I20221014000811 |
| Provider Name | Kayla Hellums |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518700079 PECOS PAC ID: 5597201327 Enrollment ID: I20240729001521 |
Prescott Family Clinic P A Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 301 Hale Ave, Prescott, AR 71857 Phone: 870-887-6651 Fax: 870-887-2008 |