Provider Demographics
NPI:1073080255
Name:HEAD, JOHN JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:HEAD
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5320 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3528
Mailing Address - Country:US
Mailing Address - Phone:501-975-5633
Mailing Address - Fax:501-227-0710
Practice Address - Street 1:5320 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3528
Practice Address - Country:US
Practice Address - Phone:501-975-5633
Practice Address - Fax:501-227-0710
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2021-08-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8748869102Medicaid