Healthcare Provider Details

I. General information

NPI: 1336055227
Provider Name (Legal Business Name): KIM BAXLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 W MARKHAM ST
LITTLE ROCK AR
72205-2123
US

IV. Provider business mailing address

9701 W MARKHAM ST
LITTLE ROCK AR
72205-2123
US

V. Phone/Fax

Practice location:
  • Phone: 501-737-4320
  • Fax: 870-770-7177
Mailing address:
  • Phone: 501-737-4320
  • Fax: 870-770-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2505002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: