Healthcare Provider Details

I. General information

NPI: 1205426145
Provider Name (Legal Business Name): RACHEL GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL DIMASSIMO

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

PO BOX 5210
GRAND FORKS ND
58206-5210
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1323
  • Fax:
Mailing address:
  • Phone: 701-205-3000
  • Fax: 701-732-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0984
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14307
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-960
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: