Healthcare Provider Details

I. General information

NPI: 1417863580
Provider Name (Legal Business Name): VALLERY CONVERSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N REYNOLDS RD
BRYANT AR
72022-3024
US

IV. Provider business mailing address

609 RHODEN RD
JUDSONIA AR
72081-9148
US

V. Phone/Fax

Practice location:
  • Phone: 501-388-0059
  • Fax:
Mailing address:
  • Phone: 501-388-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: