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: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 STATE HIGHWAY 22 W STE B
DARDANELLE AR
72834-3006
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-3004
  • Fax: 870-994-7488
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: