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PROVISION HEALTH CARE LLC
NPI 1134090061
Nurse Practitioner - Family in El Dorado, AR

Active since September 15, 2025
525 W FAULKNER ST, EL DORADO, AR 71730(870) 337-2009 Get Directions Write a Review

NPPES record last updated: September 15, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Provision Health Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVISION HEALTH CARE LLC (NPI 1134090061) is a healthcare organization registered as a family in El Dorado, Arkansas and active in the NPI registry since September 2025. The organization lists Jacey Meloy, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1134090061
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NamePROVISION HEALTH CARE LLC
Location Address525 W FAULKNER STEl Dorado, AR 71730-4518
Mailing AddressPo Box 510West Monroe, LA 71294-0510 · (318) 322-9252 · Fax (318) 322-2885
Phone(870) 337-2009
Organization SubpartYes
Authorized OfficialJacey MeloyPractice Manager · (318) 322-9252
Enumeration DateSeptember 15, 2025
NPPES CertifiedSeptember 15, 2025
✔ NPI 1134090061 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
525 W FAULKNER ST, El Dorado, AR 71730
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Provision Health Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Provision Health Care LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Taylor Waxley, APRN
Nurse Practitioner
NPI 1891646246
525 W FAULKNER ST
El Dorado, AR 71730
(318) 322-9252
✔ PECOSSame address
Gerald Stipanuk, MD
Internal Medicine
NPI 1669459905
1520 N DIVISION ST
Blytheville, AR 72315
(731) 235-0555
✔ PECOS✔ Accepts Medicare245 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provision Health Care LLC's NPI number?

The NPI number for Provision Health Care LLC is 1134090061. It was assigned to this organization in the NPPES registry on September 15, 2025.

Where is Provision Health Care LLC located?

Provision Health Care LLC is located at 525 W Faulkner St, El Dorado, AR 71730. The listed phone number is (870) 337-2009.

What is Provision Health Care LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Provision Health Care LLC enrolled in Medicare?

Yes. Provision Health Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Provision Health Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Provision Health Care LLC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Provision Health Care LLC was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.