Healthcare Provider Details

I. General information

NPI: 1477434470
Provider Name (Legal Business Name): ANTHONY JAMES BUCHANAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 BOBWHITE DR APT 143
LITTLE ROCK AR
72205-5176
US

IV. Provider business mailing address

PO BOX 4306
LITTLE ROCK AR
72214-4306
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-2035
  • Fax: 501-500-6355
Mailing address:
  • Phone: 501-837-2035
  • Fax: 501-500-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: