| Baxter Health Reppell Diabetes Clinic | |
|
614 Broadmoor Dr Mountain Home AR 72653-2903 | |
| (870) 508-3870 | |
| Not Available |
| Full Name | Baxter Health Reppell Diabetes Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 614 Broadmoor Dr, Mountain Home, Arkansas |
| Authorized Official Name and Position | Debra Henry (CFO) |
| Authorized Official Contact | 8705081003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baxter Health Reppell Diabetes Clinic 614 Broadmoor Dr Mountain Home AR 72653-2903 Ph: (870) 508-3870 | Baxter Health Reppell Diabetes Clinic 614 Broadmoor Dr Mountain Home AR 72653-2903 Ph: (870) 508-3870 |
| NPI Number | 1437423472 |
|---|---|
| Provider Enumeration Date | 03/07/2012 |
| Last Update Date | 07/17/2023 |
| Medicare PECOS PAC ID | 3274420971 |
|---|---|
| Medicare Enrollment ID | O20120525000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437423472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Arkansas) | Primary |
| Provider Name | Jessica J Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114308707 PECOS PAC ID: 2062729494 Enrollment ID: I20150917002194 |
| Provider Name | Haley Annette Tyler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114681053 PECOS PAC ID: 5294127544 Enrollment ID: I20220118000933 |
| Provider Name | Jodi Nicole Bodenhamer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063162287 PECOS PAC ID: 9830577782 Enrollment ID: I20220604000363 |
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