# WYNNE MEDICAL CLINIC PA

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

## Provider details

- **NPI number:** 1548376148
- **Authorized official:** MS. SHELIA BURROW (OFFICE MANAGER)
- **Authorized official phone:** (870) 238-2321

## Contact information

- **Practice address:** 710 FALLS BLVD S, WYNNE, AR 72396-3514
- **Practice address phone:** (870) 238-2321
- **Practice address fax:** (870) 238-0114
- **Mailing address:** PO BOX 158, WYNNE, AR 72396-0158
- **Mailing address phone:** (870) 238-2321
- **Mailing address fax:** (870) 238-0114

## Taxonomy

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

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 09/24/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102040002 | — | AR |