NPI 1730450826

Full Potential

Organisation Health Maintenance Organization Bryant, AR

Practice location

Address: 4 Park Dr, Bryant, AR 72022-2940
Phone: (201) 249-7508
Mailing address: 8109 Interstate 30, Little Rock, AR 72209-4840

Authorised official

Name: Ryan Bruce Russell
Title: Speech Therapy
Phone: (501) 562-5400

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence SP#2073 (AR)

Other Health Maintenance Organization providers in Arkansas →

Registry record

NPI: 1730450826
Entity type: Organization
NPI issued: 20 Jan 2012
Record last updated: 20 Jan 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.