Healthcare Provider Details

I. General information

NPI: 1114564028
Provider Name (Legal Business Name): MICHAEL W BELIN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N EAST ST
BENTON AR
72015-3327
US

IV. Provider business mailing address

1440 E WOODRUFF AVE
SHERWOOD AR
72120-2631
US

V. Phone/Fax

Practice location:
  • Phone: 501-381-2001
  • Fax: 501-381-2005
Mailing address:
  • Phone: 501-835-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number122746
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: