# THE CLINIC AT THE FORGING PLACE

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

## Provider details

- **NPI number:** 1255944559
- **Authorized official:** NICOLE FERGESON (CREDENTIALING/ OFFICE ADMINISTRATOR)
- **Authorized official phone:** (479) 777-8510

## Contact information

- **Practice address:** 1302 CHERRY ST, VAN BUREN, AR 72956-4543
- **Practice address phone:** (479) 310-9096
- **Practice address fax:** (479) 777-8510
- **Mailing address:** 1302 CHERRY ST, VAN BUREN, AR 72956-4543
- **Mailing address phone:** (479) 310-9096
- **Mailing address fax:** (479) 777-8510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/26/2020
- **Last updated:** 08/26/2020