Provider Demographics
NPI:1497122758
Name:JO O'GUINN-CHARLES, PLLC
Entity Type:Organization
Organization Name:JO O'GUINN-CHARLES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:O'GUINN-CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:501-343-9547
Mailing Address - Street 1:2284 SMACKOVER HWY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-8855
Mailing Address - Country:US
Mailing Address - Phone:501-343-9547
Mailing Address - Fax:
Practice Address - Street 1:2284 SMACKOVER HWY
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-8855
Practice Address - Country:US
Practice Address - Phone:501-343-9547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03631363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty