Provider Demographics
NPI:1174491468
Name:ELEVATION FAMILY HEALTHCARE, PLLC
Entity type:Organization
Organization Name:ELEVATION FAMILY HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:JAQUES
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:479-530-4744
Mailing Address - Street 1:11112 SHUMATE CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8792
Mailing Address - Country:US
Mailing Address - Phone:479-530-4744
Mailing Address - Fax:479-530-4744
Practice Address - Street 1:11112 SHUMATE CROSSING RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730
Practice Address - Country:US
Practice Address - Phone:479-530-4744
Practice Address - Fax:479-530-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty