Healthcare Provider Details

I. General information

NPI: 1447794599
Provider Name (Legal Business Name): MADHAVI PATEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SE 14TH ST
BENTONVILLE AR
72712-4900
US

IV. Provider business mailing address

3101 SE 14TH ST
BENTONVILLE AR
72712-4900
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-6199
  • Fax: 479-636-0371
Mailing address:
  • Phone: 479-986-6199
  • Fax: 479-636-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00689200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00689200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00689200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00689200
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number232311
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: