Organization
OUACHITA FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE KINCAID (PRACTICE MANAGER)
(479) 394-5068
Entity
Organization
Contact information
Practice address
1210 DEQUEEN ST, MENA, AR 71953-4132
(479) 394-5068
(479) 394-5626
Mailing address
PO BOX 1788, MENA, AR 71953-1781
(479) 394-5068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
N6236
AR
363LF0000X
Family Nurse Practitioner
Primary
A01300-ANP
AR
363LF0000X
Family Nurse Practitioner
A03080ANP
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175314762
—
AR
05
—
182122002
—
AR
01
—
5A866
PTAN
AR
01
—
5U119
PTAN
AR
Enumeration date
09/30/2008
Last updated
11/25/2013
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