Provider Demographics
NPI:1487472866
Name:MYHEALTH VILLAGE, PLLC
Entity type:Organization
Organization Name:MYHEALTH VILLAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-659-0006
Mailing Address - Street 1:PO BOX 10147
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0001
Mailing Address - Country:US
Mailing Address - Phone:501-358-6522
Mailing Address - Fax:469-621-2209
Practice Address - Street 1:930 WINGATE ST STE C2
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4837
Practice Address - Country:US
Practice Address - Phone:501-358-6522
Practice Address - Fax:469-621-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care