WESTSIDE FAMILY CLINIC LLC NPI 1801587779

NPI Information

  • NPI: 1801587779
  • Provider Name: WESTSIDE FAMILY CLINIC LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 04D2284065
  • Address: 3812 W MAIN ST
    RUSSELLVILLE, AR
    ZIP 72801
  • Phone: (479) 968-1245

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NPI Details

WESTSIDE FAMILY CLINIC LLC is a family nurse practitioner in Russellville, AR. WESTSIDE FAMILY CLINIC LLC NPI is 1801587779. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3812 W MAIN ST
RUSSELLVILLE, AR
ZIP 72801-314
Phone: (479) 968-1245

The provider's authorized official is Jeffrey Bosold .
The authorized official title is Ceo and has the following contact phone number (479) 747-2641.

The CLIA number assigned to this NPI record is 04D2284065 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 5/19/2023 and was last updated on 5/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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