Healthcare Provider Details

I. General information

NPI: 1275466070
Provider Name (Legal Business Name): WATT FAMILY WELLNESS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W MARKHAM ST
LITTLE ROCK AR
72205-3412
US

IV. Provider business mailing address

1340 JOSITA CIR
CONWAY AR
72034-5603
US

V. Phone/Fax

Practice location:
  • Phone: 501-786-9138
  • Fax:
Mailing address:
  • Phone: 501-786-9139
  • Fax: 832-324-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LYNN WATT
Title or Position: APRN/PRESIDENT
Credential: APRN
Phone: 501-786-9139