# ADVANCED AESTHETICS & WELLNESS CENTER PA, EARLMD FAMILY MEDICINE PA

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

## Provider details

- **NPI number:** 1811135809
- **Authorized official:** MR. KEVIN SAM EARL M.D. (OWNER)
- **Authorized official phone:** (479) 273-1426

## Contact information

- **Practice address:** 909 SE 28TH ST, SUITE 9, BENTONVILLE, AR 72712-3880
- **Practice address phone:** (479) 273-1426
- **Practice address fax:** (479) 271-6805
- **Mailing address:** PO BOX 1638, LOWELL, AR 72745-1638
- **Mailing address phone:** (479) 876-6077
- **Mailing address fax:** (479) 271-6805

## Taxonomy

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

## Other

- **Enumeration date:** 01/28/2009
- **Last updated:** 02/19/2019