Healthcare Provider Details

I. General information

NPI: 1356914220
Provider Name (Legal Business Name): HALEY JORDAN JOHNSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 405
LITTLE ROCK AR
72205-5306
US

IV. Provider business mailing address

500 S UNIVERSITY AVE STE 405
LITTLE ROCK AR
72205-5306
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-5511
  • Fax: 501-664-5149
Mailing address:
  • Phone: 501-664-5511
  • Fax: 501-664-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number200751
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number200751
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: