Healthcare Provider Details

I. General information

NPI: 1164626990
Provider Name (Legal Business Name): ARKANSAS CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MARSHALL ST
LITTLE ROCK AR
72202-3510
US

IV. Provider business mailing address

5026 WHITNEY LN
BENTON AR
72015-0900
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1759
  • Fax:
Mailing address:
  • Phone: 501-315-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberA01476
License Number StateAR

VIII. Authorized Official

Name: MRS. JOY ANGELA CHILDRESS
Title or Position: ADVANCED NURSE PRACTITIONER
Credential: APN
Phone: 501-364-1759