Healthcare Provider Details

I. General information

NPI: 1710952650
Provider Name (Legal Business Name): WHITE RIVER HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 HARRISON ST
BATESVILLE AR
72501-7417
US

IV. Provider business mailing address

1710 HARRISON ST
BATESVILLE AR
72501-7303
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-2100
  • Fax: 870-698-0109
Mailing address:
  • Phone: 870-698-2100
  • Fax: 870-698-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA BAXTER
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 870-262-5545