Provider Demographics
NPI:1962170894
Name:CARDINAL NATION HEALTHCARE, LLC
Entity type:Organization
Organization Name:CARDINAL NATION HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:501-326-4666
Mailing Address - Street 1:1889 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3115
Mailing Address - Country:US
Mailing Address - Phone:501-326-4666
Mailing Address - Fax:
Practice Address - Street 1:1889 FALCON WAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3115
Practice Address - Country:US
Practice Address - Phone:501-326-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care