Healthcare Provider Details

I. General information

NPI: 1609768100
Provider Name (Legal Business Name): EDAYSIA BURNETT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WOODLAND HEIGHTS RD # A
LITTLE ROCK AR
72212-2495
US

IV. Provider business mailing address

6 OLYMPIA CT APT 202
LITTLE ROCK AR
72210-4635
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-3600
  • Fax:
Mailing address:
  • Phone: 501-508-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: