Provider Demographics
NPI:1386895100
Name:DIVINE INTERVENTIONS
Entity type:Organization
Organization Name:DIVINE INTERVENTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:479-839-2670
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-1006
Mailing Address - Country:US
Mailing Address - Phone:479-839-2670
Mailing Address - Fax:479-294-6067
Practice Address - Street 1:425-A N. CENTENNIAL
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-1006
Practice Address - Country:US
Practice Address - Phone:479-839-2670
Practice Address - Fax:479-294-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02935363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty