| Malvern Family Medical Clinic | |
|
850 Henry St Malvern AR 72104-2712 | |
| (501) 337-1836 | |
| (501) 337-7935 |
| Full Name | Malvern Family Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 850 Henry St, Malvern, Arkansas |
| Authorized Official Name and Position | Shawn Purifoy (DOCTOR) |
| Authorized Official Contact | 5013371836 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Malvern Family Medical Clinic 850 Henry St Malvern AR 72104-2712 Ph: (501) 337-1836 | Malvern Family Medical Clinic 850 Henry St Malvern AR 72104-2712 Ph: (501) 337-1836 |
| NPI Number | 1295745933 |
|---|---|
| Provider Enumeration Date | 08/08/2006 |
| Last Update Date | 06/13/2008 |
| Medicare PECOS PAC ID | 0749295202 |
|---|---|
| Medicare Enrollment ID | O20100909001258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295745933 | NPI | - | NPPES |
| 160100002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E0603 (Arkansas) | Primary |
| Provider Name | Shawn W Purifoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861450942 PECOS PAC ID: 9931114493 Enrollment ID: I20060221000023 |
| Provider Name | Mona R Simms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053634485 PECOS PAC ID: 9830387877 Enrollment ID: I20101217000370 |
| Provider Name | Jennifer Garrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568845071 PECOS PAC ID: 9335456060 Enrollment ID: I20150914001386 |
| Provider Name | Norinda Harrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669938049 PECOS PAC ID: 6608117429 Enrollment ID: I20190404001299 |
| Provider Name | Kendra Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992365019 PECOS PAC ID: 9830426279 Enrollment ID: I20190808001271 |
| Provider Name | Lacy J Holley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447893987 PECOS PAC ID: 5193157949 Enrollment ID: I20191115001311 |
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