Prestige Care, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRESTIGE CARE, PLLC

Doing business as

Prestige Care - Blytheville

Practice address

1100 Medical Dr Ste C
Blytheville, AR 72315-2437

Phone

(870) 472-8403

Fax

(870) 472-8370

NPI assigned

May 15, 2025

Organization subpart

No

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

Authorized official

Name

Benjamin Wagner Carlyle

Title

Owner

Phone

(479) 498-6700

Specialties & licenses 1

Addresses

Other names 1

• Prestige Care - Blytheville Doing business as

Tax ID family

Prestige Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Prestige Care, PLLC

  • Family Medicine Physician
  • Jonesboro, AR
  • NPI 1346032208
  NPD tax ID
• Prestige Care, PLLC

  • Family Medicine Physician
  • Paragould, AR
  • NPI 1922899368
  NPD tax ID

Locations

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

{
    "created_epoch": "1747267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1255122602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9178",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728119178",
            "telephone_number": "800-824-4094",
            "fax_number": "479-968-1673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MEDICAL DR STE C",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723152437",
            "telephone_number": "870-472-8403",
            "fax_number": "870-472-8370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-15",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "CARLYLE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "WAGNER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-498-6700"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prestige Care - Blytheville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prestige Care - Blytheville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Blytheville, AR
• Providers in Blytheville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; 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.