NPIMap

Organization Active NPI

Booneville Family Clinic

  • Family Medicine Physician
  • Booneville, AR
National Provider Identifier
1922006790
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOONEVILLE FAMILY CLINIC
Practice address
128 Daniel Ave
Booneville, AR 72927-0110
Phone
(479) 675-2455
Fax
(479) 675-4940
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Anna Faye Young
Title
Clinic Manager
Phone
(479) 675-2455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X AR Primary

Addresses

Primary practice location

128 Daniel Ave
Booneville, AR 72927-0110

Mailing address

PO Box 110
128 Daniel Ave
Booneville, AR 72927-0110
Phone (479) 675-2455

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1922006790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110",
            "address_2": "128 DANIEL AVE",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729270110",
            "telephone_number": "479-675-2455",
            "fax_number": "479-675-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 DANIEL AVE",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729270110",
            "telephone_number": "479-675-2455",
            "fax_number": "479-675-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONEVILLE FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "FAYE",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "479-675-2455",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.