Hackett Family Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

HACKETT FAMILY CLINIC, LLC

Practice address

215 N Main St
Hackett, AR 72937-8801

Phone

(479) 255-6095

Fax

(479) 255-6141

NPI assigned

Mar 31, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Evelyn M Tustin

Title

Office Manager

Phone

(479) 255-6095

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1124656434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1278",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749531278",
            "telephone_number": "918-647-0670",
            "fax_number": "918-647-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N MAIN ST",
            "city": "HACKETT",
            "state": "AR",
            "postal_code": "729378801",
            "telephone_number": "479-255-6095",
            "fax_number": "479-255-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKETT FAMILY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-31",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "TUSTIN",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-255-6095"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James R. Derrick, M.A.
• Mary Byers Diaz, LPC
• Melissa Dawn Erwin, OT
• Erin Goss, CNP
• Hackett School District
• Hackett School District
• Katelyn Wilson Henderson
• Kelly K'S Speech Therapy Services, LLC
• Kids Unlimited Learning Academy of Ft. Smith

• All providers in Hackett, AR
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.