Healthcare Provider Details

I. General information

NPI: 1760016703
Provider Name (Legal Business Name): ASHLEY ELLEN SWEENEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22461 I 30 STE 402
BRYANT AR
72022-2383
US

IV. Provider business mailing address

22461 I 30 STE 402
BRYANT AR
72022-2383
US

V. Phone/Fax

Practice location:
  • Phone: 501-213-0276
  • Fax:
Mailing address:
  • Phone: 501-213-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR095491
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number124024
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124024
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: