Healthcare Provider Details

I. General information

NPI: 1992640742
Provider Name (Legal Business Name): BAILEY MADISON BURCHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WE KNIGHT DR
FORT SMITH AR
72903-6254
US

IV. Provider business mailing address

610 COLLUM LN W
ALMA AR
72921-5002
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-6702
  • Fax:
Mailing address:
  • Phone: 479-430-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number120183
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: