Provider Demographics
NPI:1093565848
Name:ARKANSAS COGNITIVE CARE LLC
Entity Type:Organization
Organization Name:ARKANSAS COGNITIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:501-642-0300
Mailing Address - Street 1:597 N STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:GOSNELL
Mailing Address - State:AR
Mailing Address - Zip Code:72315-5905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:597 N STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:GOSNELL
Practice Address - State:AR
Practice Address - Zip Code:72315-5905
Practice Address - Country:US
Practice Address - Phone:501-642-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty