Provider Demographics
NPI:1871250555
Name:MOBLEY MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:MOBLEY MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:PATE
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:870-639-6465
Mailing Address - Street 1:1906 W HILLSBORO ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6806
Mailing Address - Country:US
Mailing Address - Phone:870-639-6465
Mailing Address - Fax:870-639-6470
Practice Address - Street 1:1906 W HILLSBORO ST STE B
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6806
Practice Address - Country:US
Practice Address - Phone:870-639-6465
Practice Address - Fax:870-639-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1X1853OtherMEDICARE
AR281608762Medicaid