Healthcare Provider Details

I. General information

NPI: 1942193917
Provider Name (Legal Business Name): EXPEDITION HEALTH AND PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 HOGAN LN STE 500
CONWAY AR
72034-7970
US

IV. Provider business mailing address

821 HOGAN LN STE 500
CONWAY AR
72034-7970
US

V. Phone/Fax

Practice location:
  • Phone: 501-764-4443
  • Fax: 501-764-4454
Mailing address:
  • Phone: 501-764-4443
  • Fax: 501-764-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN SOUTHARD
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 501-764-4443