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Organization

WILD FIG, LLC

Active
Other names
Haelan
Organization subpart
No

Provider details

NPI number
Authorized official
CONNIE MARIE THOMAS DNP (OWNER/NURSE PRACTITIONER)
(618) 554-8730
Entity
Organization

Contact information

Practice address
215 N COLLEGE AVE, FAYETTEVILLE, AR 72701-4238
(479) 301-5290
Mailing address
PO BOX 205, BENTONVILLE, AR 72712-0205
(618) 554-8730

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
12/09/2024
Last updated
12/09/2024
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