# DEFY AGE MED SPA, PLLC

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

## Provider details

- **NPI number:** 1407515141
- **Authorized official:** HEATHER WHALEY MD (OWNER)
- **Authorized official phone:** (501) 554-6005

## Contact information

- **Practice address:** 2501 DAVE WARD DR STE A17, CONWAY, AR 72034-6090
- **Practice address phone:** (501) 499-9252
- **Mailing address:** 2501 DAVE WARD DR STE A17, CONWAY, AR 72034-6090
- **Mailing address phone:** (501) 499-9252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2021
- **Last updated:** 12/09/2021