Healthcare Provider Details

I. General information

NPI: 1174608012
Provider Name (Legal Business Name): CROSSETT HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 FRED LAGRONE DR
CROSSETT AR
71635-4546
US

IV. Provider business mailing address

PO BOX H
CROSSETT AR
71635-1808
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-9519
  • Fax: 870-304-2156
Mailing address:
  • Phone: 870-364-9519
  • Fax: 870-304-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY WHITE
Title or Position: HR DIRECTOR
Credential:
Phone: 870-364-1272