Provider Demographics
NPI:1891367090
Name:FAMILY PAVILION LLC
Entity Type:Organization
Organization Name:FAMILY PAVILION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:501-680-8166
Mailing Address - Street 1:1 SAINT VINCENT CIR STE 440
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5492
Mailing Address - Country:US
Mailing Address - Phone:501-680-8166
Mailing Address - Fax:501-666-8538
Practice Address - Street 1:1 SAINT VINCENT CIR STE 440
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5492
Practice Address - Country:US
Practice Address - Phone:501-680-8166
Practice Address - Fax:501-666-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty