Individual
MEGAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
545 N MAIN ST, CLARENDON, AR 72029-2017
(870) 830-6805
Mailing address
545 N MAIN ST, CLARENDON, AR 72029-2017
(870) 830-6805
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PT2580
AR
Other
Enumeration date
08/12/2015
Last updated
08/12/2015
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