Healthcare Provider Details

I. General information

NPI: 1295398865
Provider Name (Legal Business Name): ALI RENE MITCHELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 CYPRESS RD STE 100
ARKADELPHIA AR
71923-4251
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 870-246-2471
  • Fax: 870-246-2476
Mailing address:
  • Phone: 870-246-2471
  • Fax: 870-246-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-15636
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: