Healthcare Provider Details

I. General information

NPI: 1780519926
Provider Name (Legal Business Name): STACY WOMACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 W MARKHAM ST
LITTLE ROCK AR
72205-2123
US

IV. Provider business mailing address

9701 W MARKHAM ST
LITTLE ROCK AR
72205-2123
US

V. Phone/Fax

Practice location:
  • Phone: 501-737-4320
  • Fax: 870-770-7177
Mailing address:
  • Phone: 501-737-4320
  • Fax: 870-770-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: