Provider Demographics
NPI:1902534662
Name:APRN ASSOCIATES OF ARKANSAS
Entity type:Organization
Organization Name:APRN ASSOCIATES OF ARKANSAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-291-3699
Mailing Address - Street 1:606 W COMMERCE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7521
Mailing Address - Country:US
Mailing Address - Phone:501-413-8715
Mailing Address - Fax:
Practice Address - Street 1:606 W COMMERCE DR STE 1
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7521
Practice Address - Country:US
Practice Address - Phone:501-413-8715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR232728758Medicaid