Provider Demographics
NPI:1962110031
Name:WHITE OAK MEDICAL CLINIC
Entity type:Organization
Organization Name:WHITE OAK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:479-284-2012
Mailing Address - Street 1:11442 SR 27
Mailing Address - Street 2:
Mailing Address - City:HECTOR
Mailing Address - State:AR
Mailing Address - Zip Code:72843-9102
Mailing Address - Country:US
Mailing Address - Phone:479-284-2012
Mailing Address - Fax:479-284-0395
Practice Address - Street 1:11442 SR 27
Practice Address - Street 2:
Practice Address - City:HECTOR
Practice Address - State:AR
Practice Address - Zip Code:72843-9102
Practice Address - Country:US
Practice Address - Phone:479-264-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty