Westside Family Clinic LLC
Nurse Practitioner, Family in Russellville, AR. Organization (NPI-2).
NPI number1801587779
StatusActive
Last updated in NPPESMay 19, 2023
Details
- NPI
- 1801587779
- Entity type
- Organization (NPI-2)
- Legal business name
- Westside Family Clinic LLC
- Organization subpart
- No
- Enumeration date
- May 19, 2023
- Certification date
- May 19, 2023
- Last updated
- May 19, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Practice location
3812 W Main StRussellville, AR 72801-2314
Phone 479-968-1245
Mailing address
3812 W Main StRussellville, AR 72801-2314
Authorized official
Jeffrey Bosold
Ceo
4797472641
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