Healthcare Provider Details

I. General information

NPI: 1144697418
Provider Name (Legal Business Name): DR. ELISE WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 VALLEY FRG
BENTON AR
72015-3079
US

IV. Provider business mailing address

2625 VALLEY FRG
BENTON AR
72015-3079
US

V. Phone/Fax

Practice location:
  • Phone: 501-650-3657
  • Fax:
Mailing address:
  • Phone: 501-650-3657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number202350
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: