Provider Demographics
NPI:1225786916
Name:ADVANCED MEDICINE OF THE OZARKS, LTD
Entity Type:Organization
Organization Name:ADVANCED MEDICINE OF THE OZARKS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:870-232-0397
Mailing Address - Street 1:PO BOX 2457
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-2457
Mailing Address - Country:US
Mailing Address - Phone:870-232-0397
Mailing Address - Fax:870-232-0399
Practice Address - Street 1:104 DYER ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3514
Practice Address - Country:US
Practice Address - Phone:870-232-0397
Practice Address - Fax:870-232-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty