Healthcare Provider Details

I. General information

NPI: 1780108456
Provider Name (Legal Business Name): SAMANTHA CORRAL CROUCH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANATH B CORRA CNM

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8260
  • Fax: 479-443-3903
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM002133
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: