Organization
FAITH AND FAMILY MEDICAL PROVIDERS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN BLADDICK (HUMAN RESOURCES)
(479) 310-5206
Entity
Organization
Contact information
Practice address
363 HIGHWAY 371 S, MAGNOLIA, AR 71753-8960
(573) 202-4070
Mailing address
363 HIGHWAY 371 S, MAGNOLIA, AR 71753-8960
(479) 310-5206
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
Other
Enumeration date
05/05/2022
Last updated
07/11/2022
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