Misenheimer Medical, LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

License

A004788 Issued in AR

Legal business name

MISENHEIMER MEDICAL, LLC

Practice address

117 Oakhurst Blvd
El Dorado, AR 71730-3736

Phone

(870) 918-6684

NPI assigned

Jun 21, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Ambrosia Alexandra Misenheimer, FNP-C

Title

Owner/President

Phone

(870) 918-6684

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466467200000",
    "number": "1770933673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 OAKHURST BLVD",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717303736",
            "telephone_number": "870-918-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 OAKHURST BLVD",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717303736",
            "telephone_number": "870-918-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISENHEIMER MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-21",
        "last_updated": "2016-06-21",
        "status": "A",
        "authorized_official_last_name": "MISENHEIMER",
        "authorized_official_first_name": "AMBROSIA",
        "authorized_official_middle_name": "ALEXANDRA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "870-918-6684",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "AR",
            "license": "A004788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eddie D Miller
• Leslie Miller
• Marsha Requita Miller, APRN
• Shawana Miller
• Donna L Miner
• Fonda Renee Mitchell, PTA
• Mobley Medical Clinic PLLC
• Jessica P Mobley, APN
• Requebia Monk
• Shakerah Moody

• Emergency Care Clinic/Center in El Dorado, AR
• Providers in El Dorado, AR by specialty
• Emergency Care Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; 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.