Healthcare Provider Details

I. General information

NPI: 1942660980
Provider Name (Legal Business Name): ROBERT WAYNE FARLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 GREENFIELD DR
BRYANT AR
72022-8118
US

IV. Provider business mailing address

3109 GREENFIELD DR
BRYANT AR
72022-8118
US

V. Phone/Fax

Practice location:
  • Phone: 501-860-8461
  • Fax:
Mailing address:
  • Phone: 501-860-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberATP-000931
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004705
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: