Healthcare Provider Details

I. General information

NPI: 1790640274
Provider Name (Legal Business Name): ROBIN MACK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 W 5TH AVE
CROSSETT AR
71635-2500
US

IV. Provider business mailing address

790 ROBERTS DR
MONTICELLO AR
71655-5723
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-6471
  • Fax:
Mailing address:
  • Phone: 870-367-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL057156
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: