Healthcare Provider Details

I. General information

NPI: 1700634342
Provider Name (Legal Business Name): ASHLEY ECHOLS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 FRONT ST
CONWAY AR
72032-5421
US

IV. Provider business mailing address

PO BOX 1112
VILONIA AR
72173-1112
US

V. Phone/Fax

Practice location:
  • Phone: 501-900-4549
  • Fax:
Mailing address:
  • Phone: 501-733-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR085201
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: