Healthcare Provider Details

I. General information

NPI: 1972055184
Provider Name (Legal Business Name): KATRINA NICOLE GALLIVAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA NORMAN

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 CHENAL PKWY STE 101
LITTLE ROCK AR
72211-5262
US

IV. Provider business mailing address

500 S UNIVERSITY AVE STE 600
LITTLE ROCK AR
72205-5324
US

V. Phone/Fax

Practice location:
  • Phone: 501-239-9146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223712
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: