Provider Demographics
NPI:1821789785
Name:HAERTLING FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:HAERTLING FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HAERTLING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-598-4075
Mailing Address - Street 1:940 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6037
Mailing Address - Country:US
Mailing Address - Phone:870-569-4341
Mailing Address - Fax:
Practice Address - Street 1:940 23RD ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6037
Practice Address - Country:US
Practice Address - Phone:870-569-4341
Practice Address - Fax:870-569-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty