Provider Demographics
NPI:1467055707
Name:HEALTHY ARKANSAS FAMILY PRACTICE & URGENT CARE LLC
Entity Type:Organization
Organization Name:HEALTHY ARKANSAS FAMILY PRACTICE & URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:501-200-3212
Mailing Address - Street 1:1500 N HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-9209
Mailing Address - Country:US
Mailing Address - Phone:870-200-3212
Mailing Address - Fax:501-200-3213
Practice Address - Street 1:1500 N HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:AR
Practice Address - Zip Code:72132-9209
Practice Address - Country:US
Practice Address - Phone:870-200-3212
Practice Address - Fax:501-200-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty