Southern Arkansas Wound and Foot Care PLLC
Organization Active NPI Gerontology Nurse Practitioner · Smackover, AR
NPI 1114865151 · NPPES record last updated Apr 1, 2026
Key facts
- NPI
- 1114865151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- Legal business name
- SOUTHERN ARKANSAS WOUND AND FOOT CARE PLLC
- Practice address
- 4450 Smackover Hwy
Smackover, AR 71762-9533 - Phone
- (870) 814-0018
- NPI assigned
- Mar 23, 2026
- Organization subpart
- No
Authorized official
- Name
- Thomas C Head, APRN-CNP
- Title
- Owner
- Phone
- (870) 814-0018
Practitioners 1
-
Thomas Collier Head, APRN-CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260508000012 | AR | Part B Supplier - Clinic/Group Practice | 6204304223 |
Receives reassigned benefits from 1 practitioner Practice locations: Smackover, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner |
363LA2200X | |||
| Gerontology Nurse Practitioner |
363LG0600X | Yes |
Addresses
Primary practice location
4450 Smackover Hwy
Smackover, AR 71762-9533
Mailing address
4450 Smackover Hwy
Smackover, AR 71762-9533
Other providers in Smackover, AR
- Saffold Therapy. LLC
- Smackover Family Pharmacy, LLC
- Smackover School District
- Smith Spine and Wellness PLLC
- Hope Elizabeth Smith
- Victoria Still
- Mary White
- Maddisyn Wilkinson
All providers in Smackover, AR · Gerontology Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.