Provider Demographics
NPI:1386214872
Name:TOTAL ACCESS SOLUTIONS
Entity Type:Organization
Organization Name:TOTAL ACCESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FNP
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:870-621-0080
Mailing Address - Street 1:1420 OWL RDG
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-0021
Mailing Address - Country:US
Mailing Address - Phone:870-621-0080
Mailing Address - Fax:
Practice Address - Street 1:3809 E 9TH ST STE 15
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5818
Practice Address - Country:US
Practice Address - Phone:870-621-0080
Practice Address - Fax:870-621-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR271834762Medicaid