Caddo River Medical Clinic PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

CADDO RIVER MEDICAL CLINIC PLLC

Practice address

180 Highway 70 E Ste 11
Glenwood, AR 71943-8810

Phone

(870) 669-9840

NPI assigned

Jul 10, 2026

Last updated

Sep 22, 2026By 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

Rickey Edna Mack, APRNNPI 1528560513

Title

Owner

Phone

(870) 828-1151

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rickey Edna Mack, CNP

  • Family Nurse Practitioner
  • Glenwood, AR
  • NPI 1528560513
  NPD (past) Authorized official

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

{
    "created_epoch": "1783641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1194644575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 HIGHWAY 8 E",
            "city": "GLENWOOD",
            "state": "AR",
            "postal_code": "719439222",
            "telephone_number": "870-669-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 HIGHWAY 70 E STE 11",
            "city": "GLENWOOD",
            "state": "AR",
            "postal_code": "719438810",
            "telephone_number": "870-669-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CADDO RIVER MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-10",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "RICKEY",
        "authorized_official_middle_name": "EDNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-828-1151",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elisabeth Blackmon, MS, OTR/L
• Jaclyn Bowen, QBHP
• Amanda Brown
• Bucks Pharmacy Inc
• Bucks Pharmacy Inc (Bucks Pharmacy)
• Alexus Caldwell, QBHP
• Kayla Caldwell, QBHP
• Justin Neil Carter, COTA/L
• Stacie Chancellor
• CHI St. Vincent Medical Group Hot Springs

• Clinic/Center in Glenwood, AR
• Providers in Glenwood, AR by specialty
• Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; 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.