Healthcare Provider Details

I. General information

NPI: 1639785884
Provider Name (Legal Business Name): LISA ANN ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 N RODNEY PARHAM RD STE B5
LITTLE ROCK AR
72212-4199
US

IV. Provider business mailing address

10720 N RODNEY PARHAM RD STE B5
LITTLE ROCK AR
72212-4199
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-7468
  • Fax: 501-224-1834
Mailing address:
  • Phone: 501-225-7468
  • Fax: 501-224-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR86974
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: