Healthcare Provider Details

I. General information

NPI: 1376403642
Provider Name (Legal Business Name): SKY BLOSSOM LOGISTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 ROGERS AVE STE 201
FORT SMITH AR
72901-1941
US

IV. Provider business mailing address

2209 BRECKENRIDGE TER
GREENWOOD AR
72936-6403
US

V. Phone/Fax

Practice location:
  • Phone: 479-352-9281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: RYAN MILLICAN
Title or Position: OWNER
Credential:
Phone: 479-352-9281