Individual
TYNESHIA BOHANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 COMMERCIAL CENTER DR STE 2, MARION, AR 72364-9616
(870) 732-7920
Mailing address
2809 FOREST HOME RD, JONESBORO, AR 72401-5320
(866) 972-1268
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3273-M
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182339795
—
AR
Enumeration date
03/13/2007
Last updated
09/01/2020
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