Healthcare Provider Details

I. General information

NPI: 1952263147
Provider Name (Legal Business Name): EMMA PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 FOUNTAIN DR
CONWAY AR
72034-3689
US

IV. Provider business mailing address

3025 FOUNTAIN DR STE 100
CONWAY AR
72034-3690
US

V. Phone/Fax

Practice location:
  • Phone: 501-269-1656
  • Fax: 501-325-1255
Mailing address:
  • Phone: 501-269-1656
  • Fax: 501-325-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: