Healthcare Provider Details

I. General information

NPI: 1033949409
Provider Name (Legal Business Name): HALEY NICOLE LEDBETTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK DR
BENTON AR
72015-3353
US

IV. Provider business mailing address

891 E COUNTY LINE RD
ARKADELPHIA AR
71923-8518
US

V. Phone/Fax

Practice location:
  • Phone: 501-776-6000
  • Fax:
Mailing address:
  • Phone: 870-403-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229973
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: