Healthcare Provider Details

I. General information

NPI: 1427335835
Provider Name (Legal Business Name): BRIEANNA R BREEDING APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MEADOWLAKE RD STE 10
CONWAY AR
72032-2569
US

IV. Provider business mailing address

9500 KANIS RD SUITE 101
LITTLE ROCK AR
72205-6324
US

V. Phone/Fax

Practice location:
  • Phone: 15-133-3225
  • Fax: 501-513-3065
Mailing address:
  • Phone: 501-202-1902
  • Fax: 501-202-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1427335835
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03620
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: