Provider Demographics
NPI:1063871044
Name:OPEN DOOR HEALTH AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:OPEN DOOR HEALTH AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:479-294-6151
Mailing Address - Street 1:425 N CENTENNIAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-2708
Mailing Address - Country:US
Mailing Address - Phone:479-294-6151
Mailing Address - Fax:479-294-6152
Practice Address - Street 1:425 N CENTENNIAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-2708
Practice Address - Country:US
Practice Address - Phone:479-294-6151
Practice Address - Fax:479-294-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty