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Organization
DEFY AGE MED SPA, PLLC
Active
Organization
DEFY AGE MED SPA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER WHALEY MD (OWNER)
(501) 554-6005
Entity
Organization
Contact information
Practice address
2501 DAVE WARD DR STE A17, CONWAY, AR 72034-6090
(501) 499-9252
Mailing address
2501 DAVE WARD DR STE A17, CONWAY, AR 72034-6090
(501) 499-9252
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
12/09/2021
Last updated
12/09/2021
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