Healthcare Provider Details

I. General information

NPI: 1174057376
Provider Name (Legal Business Name): MRS. HANNAH BAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W CARPENTER ST
BENTON AR
72015-3349
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 501-778-8264
  • Fax: 501-778-7360
Mailing address:
  • Phone: 501-778-8264
  • Fax: 501-778-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR095319
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005206
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: