Provider Demographics
NPI:1720482482
Name:OZARK WELLNESS CLINIC PLLC
Entity type:Organization
Organization Name:OZARK WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVONIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNS
Authorized Official - Phone:479-667-2222
Mailing Address - Street 1:102 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-2850
Mailing Address - Country:US
Mailing Address - Phone:479-667-2222
Mailing Address - Fax:479-667-2252
Practice Address - Street 1:102 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-2850
Practice Address - Country:US
Practice Address - Phone:479-667-2222
Practice Address - Fax:479-667-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5001039363LF0000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty