Provider Demographics
NPI:1013589704
Name:HOMETOWN HEALTHCARE OF THE RIVER VALLEY, PLLC
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE OF THE RIVER VALLEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:479-774-9992
Mailing Address - Street 1:107 S CRAVENS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3607
Mailing Address - Country:US
Mailing Address - Phone:479-774-9992
Mailing Address - Fax:
Practice Address - Street 1:107 S CRAVENS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3607
Practice Address - Country:US
Practice Address - Phone:479-774-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty