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Organization
WILD FIG, LLC
Active
Organization
WILD FIG, LLC
Active
Other names
Haelan
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE MARIE THOMAS DNP (OWNER/NURSE PRACTITIONER)
(618) 554-8730
Entity
Organization
Contact information
Practice address
215 N COLLEGE AVE, FAYETTEVILLE, AR 72701-4238
(479) 301-5290
Mailing address
PO BOX 205, BENTONVILLE, AR 72712-0205
(618) 554-8730
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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