Provider Demographics
NPI:1689357816
Name:PHARIS, VIRGINIA COLLIE (QBHP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:COLLIE
Last Name:PHARIS
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:COLLIE
Other - Last Name:BROADUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QBHP
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-336-1339
Practice Address - Street 1:75 HWY 62/412
Practice Address - Street 2:STE J
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9629
Practice Address - Country:US
Practice Address - Phone:870-994-7060
Practice Address - Fax:870-994-7063
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator