Healthcare Provider Details

I. General information

NPI: 1215671938
Provider Name (Legal Business Name): MOLLY TIBBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 589
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

1615 FAIR PARK BLVD
LITTLE ROCK AR
72204-2717
US

V. Phone/Fax

Practice location:
  • Phone: 501-526-8148
  • Fax:
Mailing address:
  • Phone: 870-692-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: