Provider Demographics
NPI:1104245182
Name:OUSLEY, BENNIE JR
Entity type:Individual
Prefix:MR
First Name:BENNIE
Middle Name:
Last Name:OUSLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72316-0006
Mailing Address - Country:US
Mailing Address - Phone:870-714-2188
Mailing Address - Fax:
Practice Address - Street 1:829 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2521
Practice Address - Country:US
Practice Address - Phone:870-714-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator