Provider Demographics
NPI:1841022118
Name:NATURAL STATE MENTAL HEALTH AND INTEGRATIVE MEDICINE, PLLC
Entity type:Organization
Organization Name:NATURAL STATE MENTAL HEALTH AND INTEGRATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-275-3072
Mailing Address - Street 1:3105 VILLAGE CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7768
Mailing Address - Country:US
Mailing Address - Phone:870-275-3072
Mailing Address - Fax:
Practice Address - Street 1:3105 VILLAGE CV
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7768
Practice Address - Country:US
Practice Address - Phone:870-275-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty