Provider Demographics
NPI:1942748488
Name:INTEGRITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:INTEGRITY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANNOAH
Authorized Official - Middle Name:MCKINDRA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, FNP-BC
Authorized Official - Phone:870-329-4730
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2917
Mailing Address - Country:US
Mailing Address - Phone:870-329-4730
Mailing Address - Fax:
Practice Address - Street 1:1210 S CHERRY ST STE 4
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5667
Practice Address - Country:US
Practice Address - Phone:870-329-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03593261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188901758Medicaid
294078YXDKMedicare UPIN