NPIMap

Organization Active NPI

Advanced Aesthetics & Wellness Center PA, Earlmd Family Medicine PA

  • Family Medicine Physician
  • Bentonville, AR
National Provider Identifier
1811135809
Registry record updated Feb 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ADVANCED AESTHETICS & WELLNESS CENTER PA, EARLMD FAMILY MEDICINE PA
Practice address
909 SE 28TH St
Suite 9
Bentonville, AR 72712-3880
Phone
(479) 273-1426
Fax
(479) 271-6805
NPI assigned
Jan 28, 2009
Last updated
Feb 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2019

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

Authorized official

Name
Mr. Kevin Sam Earl, M.D.
Title
Owner
Phone
(479) 273-1426

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

909 SE 28TH St
Suite 9
Bentonville, AR 72712-3880

Mailing address

PO Box 1638
Lowell, AR 72745-1638
Phone (479) 876-6077

National Provider Directory

National Provider Directory

Locations

909 SE 28th St
Ste 9
Bentonville, AR 72712
Phone (479) 273-1426

Practitioners & affiliated clinicians

Practitioners 63

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.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1233100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550534400000",
    "number": "1811135809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1638",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727451638",
            "telephone_number": "479-876-6077",
            "fax_number": "479-271-6805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 SE 28TH ST",
            "address_2": "SUITE 9",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123880",
            "telephone_number": "479-273-1426",
            "fax_number": "479-271-6805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED AESTHETICS & WELLNESS CENTER PA, EARLMD FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-28",
        "last_updated": "2019-02-19",
        "status": "A",
        "authorized_official_last_name": "EARL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-273-1426",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; 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.