Individual
SAMUEL MENDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN, QBHP
Contact information
Practice address
3111 S 70TH ST, FORT SMITH, AR 72903-5017
(479) 452-6650
(479) 452-5847
Mailing address
PO BOX 11818, FORT SMITH, AR 72917-1818
(479) 452-6650
(479) 452-5847
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L056222
AR
171M00000X
Case Manager/Care Coordinator
QBPH
AR
Other
Enumeration date
07/16/2018
Last updated
07/16/2018
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