Modern Medicine PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

E1887 Issued in AR

Legal business name

MODERN MEDICINE PLLC

Practice address

350 E Millsap Rd
Fayetteville, AR 72703-4098

Phone

(479) 439-8020

Fax

(479) 439-8022

NPI assigned

Mar 13, 2013

Last updated

Mar 13, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lonnie Joseph Parker, MD

Title

Sole Member

Phone

(870) 826-7500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363132800000",
    "number": "1144561390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 E MILLSAP RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034098",
            "telephone_number": "479-439-8020",
            "fax_number": "479-439-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 E MILLSAP RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034098",
            "telephone_number": "479-439-8020",
            "fax_number": "479-439-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-13",
        "last_updated": "2013-03-13",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "LONNIE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "870-826-7500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "E1887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Eugene Mitchell IV, M.D.
• Shelly Amanda Mitchell, RD
• Amanda Emily Mitzel, LCSW
• Whitney Paige Mobley, APRN, FNP-C, FNP-BC
• Jennifer Noelle Moclair, PHARMD, RPH
• Rachel Anne Modersitzki, DO
• Sophia M Moes, RD
• Jennifer Moffitt, LPE-I
• Charles Mohr
• Sandra M Mondragon

• General Practice Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• General Practice Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; 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.