Healthcare Provider Details

I. General information

NPI: 1699679787
Provider Name (Legal Business Name): LATRISHAHALLDO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OAK ST
CONWAY AR
72032-5316
US

IV. Provider business mailing address

701 SOUTH ST STE 100
MOUNTAIN HOME AR
72653-4452
US

V. Phone/Fax

Practice location:
  • Phone: 501-764-4800
  • Fax:
Mailing address:
  • Phone: 501-764-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LATRISHA HALL
Title or Position: PHYSICIAN/ OWNER
Credential: DO
Phone: 501-764-4800