# ARKANSAS PHS PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDER HEALTH SERVICES LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194956516
- **Legal business name:** PROVIDER HEALTH SERVICES LLC
- **Authorized official:** NICOLE HOWARD (CFO)
- **Authorized official phone:** (337) 991-9276

## Contact information

- **Practice address:** 609 SW 8TH STREET, SUITE 600, BENTONVILLE, AR 72712-8913
- **Practice address phone:** (901) 261-4848
- **Practice address fax:** (901) 261-4849
- **Mailing address:** 1509 DULLES DRIVE, LAFAYETTE, LA 70506
- **Mailing address phone:** (337) 991-9276
- **Mailing address fax:** (337) 991-9288

## Taxonomy

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

## Other

- **Enumeration date:** 08/03/2009
- **Last updated:** 07/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 190440762 | — | AR |