Defy Age Med Spa, PLLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

DEFY AGE MED SPA, PLLC

Practice address

2501 Dave Ward Dr Ste A17
Conway, AR 72034-6090

Phone

(501) 499-9252

NPI assigned

Dec 9, 2021

Organization subpart

No

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

Authorized official

Name

Heather Whaley, MD

Title

Owner

Phone

(501) 554-6005

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639008000000",
    "number": "1407515141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 DAVE WARD DR STE A17",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346090",
            "telephone_number": "501-499-9252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 DAVE WARD DR STE A17",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346090",
            "telephone_number": "501-499-9252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEFY AGE MED SPA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A",
        "authorized_official_last_name": "WHALEY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-554-6005",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Conway, AR
• Providers in Conway, AR by specialty
• Pain Medicine (Anesthesiology) Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.