Healthcare Provider Details

I. General information

NPI: 1710896170
Provider Name (Legal Business Name): MARY ELLIOTT RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 LYNX LN
JONESBORO AR
72405-0657
US

IV. Provider business mailing address

4112 LYNX LN
JONESBORO AR
72405-0657
US

V. Phone/Fax

Practice location:
  • Phone: 870-275-0879
  • Fax:
Mailing address:
  • Phone: 870-275-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberRCP-3840
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: