Provider Demographics
NPI:1346848850
Name:ARKANSAS PREMIER MEDICAL CLINIC
Entity Type:Organization
Organization Name:ARKANSAS PREMIER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN/PART OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:ROAS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:501-303-8289
Mailing Address - Street 1:8524 HART RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22461 I 30 STE 402
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2383
Practice Address - Country:US
Practice Address - Phone:501-303-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1235655531OtherNPI
AR1326282799OtherNPI