DR. RICHARD D BACK (NPI# 1528082096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528082096 |
| Entity Type | Individual |
| Full Name | DR. RICHARD D BACK |
| Credential | PH.D |
| Practice Address |
1706 E Joyce Blvd Suite 3 Fayetteville AR 72703-5238 |
| Practice Telephone | 4794429381 |
| Practice Fax Number | 4794429396 |
| Mailing Telephone | 4794429381 |
| Mailing Fax Number | 4794429396 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-05-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 78-18 P | AR | Behavioral Health & Social Service Providers |
| Street Address |
1706 E JOYCE BLVD SUITE 3 |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-5238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609823780 | Kelly Richard Danks | Neurological Surgery | 1706 E Joyce Blvd, 2, Fayetteville, AR 72703-5238 | 2006-05-27 |
| 1598864043 | Nw Arkansas Psychological Group Inc | Psychologist | 1706 E Joyce Blvd, Suite 3, Fayetteville, AR 72703-5238 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538215660 | Ronald Eugene Mcinroe | Clinical Neuropsychologist | 217 North East, Fayetteville, AR 72701 | 2007-01-25 |
| 1881749539 | G. Martin Woodard | Clinical Neuropsychologist | 2711 Breezewood Ave, Suite A - 5, Fayetteville, NC 28303-5504 | 2007-01-24 |
| 1194816512 | James W Mikesell | Clinical Neuropsychologist | 7000 E Genesee St Bldg C, Fayetteville, NY 13066 | 2006-09-28 |
| 1700802485 | James M Fuendeling | Clinical Neuropsychologist | 2013 N Green Acres Rd, Suite C, Fayetteville, AR 72703-2619 | 2006-07-14 |
| 1649205006 | Anne Ward Stevens | Clinical Neuropsychologist | 86 W Sunbridge Dr, Fayetteville, AR 72703-1822 | 2006-07-12 |
| 1871527267 | Harvey E Chambers | Clinical Neuropsychologist | 2592 N Gregg Ave Ste 16, Fayetteville, AR 72703-5541 | 2006-07-10 |
| 1447202809 | Daniel J Johnson | Clinical Neuropsychologist | 1100 North College Ave, Veteran Health Care System of The Ozarks, Fayetteville, AR 72703 | 2006-05-16 |
| 1962476010 | Fred Harry Brown Jr. | Clinical Neuropsychologist | 268 Waxhaw St, Fayetteville, NC 28314-8628 | 2006-02-15 |
| 1093716672 | Elizabeth Ann Gamble | Clinical Neuropsychologist | 559 Executive Pl Ste 102, Fayetteville, NC 28305-5154 | 2005-08-09 |
| 1053830315 | Fayetteville Neuropsychology Pllc | Clinical Neuropsychologist | 559 Executive Pl Ste 102, Fayetteville, NC 28305-5154 | 2017-09-18 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.