Healthcare Provider Details

I. General information

NPI: 1730611005
Provider Name (Legal Business Name): EMILY RUTH CRAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 CANTRELL RD
LITTLE ROCK AR
72223-4565
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-8957
  • Fax: 501-364-6299
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-16673
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberE-16673
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: