Healthcare Provider Details

I. General information

NPI: 1134252414
Provider Name (Legal Business Name): STATE OF ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W 10TH ST SUITE 300
LITTLE ROCK AR
72204-1752
US

IV. Provider business mailing address

MATERNAL INFANT SLOT H5 PO BOX 1437
LITTLE ROCK AR
72203-1437
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-2873
  • Fax: 501-280-4619
Mailing address:
  • Phone: 501-661-2873
  • Fax: 501-280-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN GRAZIANI
Title or Position: DIRECTOR
Credential:
Phone: 501-661-2154