Healthcare Provider Details

I. General information

NPI: 1336072859
Provider Name (Legal Business Name): TRISTANN WOOTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 900
LITTLE ROCK AR
72205-6331
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-1135
  • Fax: 501-224-1198
Mailing address:
  • Phone: 501-224-1135
  • Fax: 501-224-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number215719
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215719
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: