Healthcare Provider Details

I. General information

NPI: 1174095830
Provider Name (Legal Business Name): SHIRLEY M CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 DURWOOD RD
LITTLE ROCK AR
72207-3431
US

IV. Provider business mailing address

2312 DURWOOD RD
LITTLE ROCK AR
72207-3431
US

V. Phone/Fax

Practice location:
  • Phone: 501-313-5973
  • Fax:
Mailing address:
  • Phone: 501-313-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-70646
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: