Healthcare Provider Details

I. General information

NPI: 1669012878
Provider Name (Legal Business Name): JAMES RYAN CARROLL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ROSEMOUNT DR
CONWAY AR
72034-2925
US

IV. Provider business mailing address

6 ROSEMOUNT DR
CONWAY AR
72034-2925
US

V. Phone/Fax

Practice location:
  • Phone: 501-472-2480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123428
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: