Provider Demographics
NPI:1487102596
Name:MCCORMACK, JAMES (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MCCORMACK
Suffix:
Gender:M
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DEERBERRY FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4427
Mailing Address - Country:US
Mailing Address - Phone:903-277-5517
Mailing Address - Fax:
Practice Address - Street 1:855 S GERMAN LN STE 1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6479
Practice Address - Country:US
Practice Address - Phone:903-277-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-18
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223079363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health