Healthcare Provider Details

I. General information

NPI: 1154033140
Provider Name (Legal Business Name): MAGGI LENEE SCROGGINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3493 BELLA VISTA WAY
BELLA VISTA AR
72714-5740
US

IV. Provider business mailing address

PO BOX 775641
CHICAGO IL
60677-5641
US

V. Phone/Fax

Practice location:
  • Phone: 479-265-3712
  • Fax: 479-265-3713
Mailing address:
  • Phone: 479-265-3712
  • Fax: 479-265-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1146
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: