Healthcare Provider Details

I. General information

NPI: 1477418655
Provider Name (Legal Business Name): BROOKLIN RYLI FAULKENBERRY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKLIN R EWARDS

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 COTTAGE DR
LITTLE ROCK AR
72205-5400
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8674
  • Fax: 501-526-7217
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPT2026-013
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: