Provider Demographics
NPI:1922532837
Name:NURSE PRACTITIONERS FAMILY CLINIC
Entity Type:Organization
Organization Name:NURSE PRACTITIONERS FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:870-458-3187
Mailing Address - Street 1:9798 HIGHWAY 62 WEST
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72583
Mailing Address - Country:US
Mailing Address - Phone:870-458-6732
Mailing Address - Fax:
Practice Address - Street 1:9798 HIGHWAY 62 WEST
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:AR
Practice Address - Zip Code:72583
Practice Address - Country:US
Practice Address - Phone:870-458-6732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004928261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center