# WILD FIG, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Haelan
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770399305
- **Authorized official:** CONNIE MARIE THOMAS DNP (OWNER/NURSE PRACTITIONER)
- **Authorized official phone:** (618) 554-8730

## Contact information

- **Practice address:** 215 N COLLEGE AVE, FAYETTEVILLE, AR 72701-4238
- **Practice address phone:** (479) 301-5290
- **Mailing address:** PO BOX 205, BENTONVILLE, AR 72712-0205
- **Mailing address phone:** (618) 554-8730

## Taxonomy

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

## Other

- **Enumeration date:** 12/09/2024
- **Last updated:** 12/09/2024