Healthcare Provider Details

I. General information

NPI: 1912141730
Provider Name (Legal Business Name): NATURAL STATE HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 CANTRELL RD SUITE #4
LITTLE ROCK AR
72223-1701
US

IV. Provider business mailing address

12911 CANTRELL RD SUITE #4
LITTLE ROCK AR
72223-1701
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1224
  • Fax: 501-224-1230
Mailing address:
  • Phone: 501-224-1224
  • Fax: 501-224-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACI A KIERNAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 501-224-1224