Provider Demographics
NPI:1932087210
Name:SKINNY FOX WEIGHT LOSS & MEDICAL CLINIC, LLC.
Entity type:Organization
Organization Name:SKINNY FOX WEIGHT LOSS & MEDICAL CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:870-773-1111
Mailing Address - Street 1:422 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5310
Mailing Address - Country:US
Mailing Address - Phone:870-773-1111
Mailing Address - Fax:870-772-1354
Practice Address - Street 1:422 BEECH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5310
Practice Address - Country:US
Practice Address - Phone:870-773-1111
Practice Address - Fax:870-772-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty