| Fountain Lake Family Medicine | |
|
4517 Park Ave Hot Springs AR 71901-9476 | |
| (501) 623-7900 | |
| (501) 623-7337 |
| Full Name | Fountain Lake Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 4517 Park Ave, Hot Springs, Arkansas |
| Authorized Official Name and Position | Richard R Finch (PROVIDER) |
| Authorized Official Contact | 5016257500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Lake Family Medicine 1661 Airport Rd Suite D Hot Springs AR 71913-7951 Ph: (501) 625-7500 | Fountain Lake Family Medicine 4517 Park Ave Hot Springs AR 71901-9476 Ph: (501) 623-7900 |
| NPI Number | 1316279375 |
|---|---|
| Provider Enumeration Date | 02/02/2010 |
| Last Update Date | 08/26/2014 |
| Medicare PECOS PAC ID | 5698665685 |
|---|---|
| Medicare Enrollment ID | O20111013000427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316279375 | NPI | - | NPPES |
| DS0108 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard Ross Finch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821049453 PECOS PAC ID: 5092605758 Enrollment ID: I20040317000314 |
| Provider Name | Karen Sue Hanig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659351864 PECOS PAC ID: 7911998810 Enrollment ID: I20040519001654 |
| Provider Name | Fred L Lyles |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609826486 PECOS PAC ID: 3072595941 Enrollment ID: I20040603001182 |
| Provider Name | Billie Pool |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740289214 PECOS PAC ID: 7214079821 Enrollment ID: I20100120000493 |
| Provider Name | Naomi Dian D Dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760707251 PECOS PAC ID: 0244364941 Enrollment ID: I20100817000969 |
| Provider Name | Natalie E Summitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417210543 PECOS PAC ID: 5890943583 Enrollment ID: I20120921000701 |
| Provider Name | Brent Fikes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609165364 PECOS PAC ID: 9638310030 Enrollment ID: I20130727000266 |
| Provider Name | Tameisha Gayle Baxter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811313554 PECOS PAC ID: 6002030855 Enrollment ID: I20140617001497 |
| Provider Name | Stephanie Ann Ragsdale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467763110 PECOS PAC ID: 8022234087 Enrollment ID: I20140728001780 |
| Provider Name | Christina Marie Gillenwater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811326861 PECOS PAC ID: 2466672043 Enrollment ID: I20141002000460 |
| Provider Name | Bridgett N Brantley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619368420 PECOS PAC ID: 0446579692 Enrollment ID: I20150511000108 |
| Provider Name | Stacy L Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679931760 PECOS PAC ID: 0143526368 Enrollment ID: I20160314001306 |
| Provider Name | Denise A Patton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588014294 PECOS PAC ID: 9931492550 Enrollment ID: I20160720000209 |
| Provider Name | Alisha Kristen Ashley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912208067 PECOS PAC ID: 6608010699 Enrollment ID: I20170302000424 |
| Provider Name | Samantha K Lampi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124537162 PECOS PAC ID: 2860758554 Enrollment ID: I20171114000052 |
| Provider Name | Michelle Auld |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336699941 PECOS PAC ID: 0042570558 Enrollment ID: I20180201000626 |
| Provider Name | Chance Osburn |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598248031 PECOS PAC ID: 9537408398 Enrollment ID: I20190222001665 |
| Provider Name | Susan Rachelle Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013489590 PECOS PAC ID: 3577802933 Enrollment ID: I20190228002745 |
| Provider Name | Norinda Harrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669938049 PECOS PAC ID: 6608117429 Enrollment ID: I20190404001299 |
| Provider Name | Gregory D Sketas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710340088 PECOS PAC ID: 3375823255 Enrollment ID: I20190515001685 |
| Provider Name | Anna Marie Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689228975 PECOS PAC ID: 0143550525 Enrollment ID: I20190927000917 |
| Provider Name | Dorothy Kathleen Ray |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1548893308 PECOS PAC ID: 5193153617 Enrollment ID: I20200317000697 |
| Provider Name | Sahithi Pothuganti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124481262 PECOS PAC ID: 0244522324 Enrollment ID: I20200406001455 |
| Provider Name | Brittany Camille Flynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093335879 PECOS PAC ID: 2264842079 Enrollment ID: I20201106000855 |
| Provider Name | Ashley Michelle Rima |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437758026 PECOS PAC ID: 6305257106 Enrollment ID: I20201130002961 |
| Provider Name | Natalie S Manatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851902118 PECOS PAC ID: 6507277233 Enrollment ID: I20201201001270 |
| Provider Name | Laura Odle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013513589 PECOS PAC ID: 3779995956 Enrollment ID: I20201211000896 |
| Provider Name | Kelsey Jordan Hale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760077069 PECOS PAC ID: 5395152722 Enrollment ID: I20210331000157 |
| Provider Name | Kimberly O Laflora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801407440 PECOS PAC ID: 9830507847 Enrollment ID: I20210412001797 |
| Provider Name | Laticia Kay Sheffield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871013359 PECOS PAC ID: 3577833458 Enrollment ID: I20210528000111 |
| Provider Name | Sandy Jeanette Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205406709 PECOS PAC ID: 6002218658 Enrollment ID: I20210706001801 |
| Provider Name | Elvira Monica Liga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477207678 PECOS PAC ID: 7618360611 Enrollment ID: I20220216000845 |
| Provider Name | Ty Anthony Humphreys |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588396600 PECOS PAC ID: 4688059595 Enrollment ID: I20220913003220 |
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