Healthcare Provider Details

I. General information

NPI: 1871103028
Provider Name (Legal Business Name): ROBIN BROWN ELLIOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT VINCENT CIR STE 120
LITTLE ROCK AR
72205-5406
US

IV. Provider business mailing address

PO BOX 1515
DURANT OK
74702-1515
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-2660
  • Fax:
Mailing address:
  • Phone: 661-262-7479
  • Fax: 661-249-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA13806
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberPA-926
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPT2020-048
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA-926
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: