Healthcare Provider Details

I. General information

NPI: 1487522892
Provider Name (Legal Business Name): BRIANNA NICOLE CUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

6508 W 3RD ST
LITTLE ROCK AR
72205-5102
US

V. Phone/Fax

Practice location:
  • Phone: 870-565-2561
  • Fax:
Mailing address:
  • Phone: 870-565-2561
  • 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 StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: