| Diffine Family Practice PLLC | |
|
1100 Medical Plaza Drive South Suite C Blytheville AR 72315 | |
| (870) 824-2809 | |
| (870) 762-0731 |
| Full Name | Diffine Family Practice PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1100 Medical Plaza Drive South, Blytheville, Arkansas |
| Authorized Official Name and Position | David a Diffine (PRESIDENT) |
| Authorized Official Contact | 8708242809 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diffine Family Practice PLLC Po Box 9178 Russellville AR 72811-9178 Ph: (800) 824-4094 | Diffine Family Practice PLLC 1100 Medical Plaza Drive South Suite C Blytheville AR 72315 Ph: (870) 824-2809 |
| NPI Number | 1962707158 |
|---|---|
| Provider Enumeration Date | 01/19/2011 |
| Last Update Date | 02/07/2024 |
| Certification Date | 02/07/2024 |
| Medicare PECOS PAC ID | 4486836657 |
|---|---|
| Medicare Enrollment ID | O20110309000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962707158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E-3767 (Arkansas) | Primary |
| Provider Name | Bethany Allison Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346339066 PECOS PAC ID: 5294757233 Enrollment ID: I20051219000878 |
| Provider Name | Heather Key |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780099598 PECOS PAC ID: 5193947042 Enrollment ID: I20141110002464 |
| Provider Name | Stephanie Leigh Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275204091 PECOS PAC ID: 8527466754 Enrollment ID: I20211001001735 |
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