# TUCKER FAMILY MEDICINE OF ARKANSAS, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063508299
- **Authorized official:** MR. DONALD L TUCKER JR. (BUSINESS MANAGER)
- **Authorized official phone:** (870) 405-8579

## Contact information

- **Practice address:** 2905 S WALTON BLVD, STE. 17, BENTONVILLE, AR 72712-6730
- **Practice address phone:** (870) 405-8579
- **Mailing address:** 103 SOMERSET, BENTONVILLE, AR 72712-4091
- **Mailing address phone:** (479) 270-8970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | AR | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 11/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 158496002 | — | AR |