Healthcare Provider Details

I. General information

NPI: 1831833383
Provider Name (Legal Business Name): HOLLIE B ROSEBERRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 WOMENS CENTER LN
HOT SPRINGS AR
71913-6352
US

IV. Provider business mailing address

1030 COOPER RD
MALVERN AR
72104-8603
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-2229
  • Fax:
Mailing address:
  • Phone: 501-337-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216491
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: