Healthcare Provider Details

I. General information

NPI: 1356065205
Provider Name (Legal Business Name): MADISON A BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON A HERRING

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST
HARRISON AR
72601-2900
US

IV. Provider business mailing address

702 N MAIN ST
HARRISON AR
72601-2900
US

V. Phone/Fax

Practice location:
  • Phone: 870-204-5330
  • Fax:
Mailing address:
  • Phone: 870-204-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4760
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: