Provider Demographics
NPI:1295863819
Name:BOSTICK, TIMOTHY ISAAC (CASE MANAGER PARAPRO)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ISAAC
Last Name:BOSTICK
Suffix:
Gender:M
Credentials:CASE MANAGER PARAPRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 S OSWEGO AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2673
Mailing Address - Country:US
Mailing Address - Phone:479-967-3370
Mailing Address - Fax:479-967-2775
Practice Address - Street 1:1505 S OSWEGO AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2673
Practice Address - Country:US
Practice Address - Phone:479-967-3370
Practice Address - Fax:479-967-2775
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator