Healthcare Provider Details

I. General information

NPI: 1831514306
Provider Name (Legal Business Name): LARRAH E HUTCHISON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARRAH E JENKINS

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT VINCENT CIR STE 210
LITTLE ROCK AR
72205-5407
US

IV. Provider business mailing address

PO BOX 23410
LITTLE ROCK AR
72221-3410
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-6830
  • Fax: 501-552-4170
Mailing address:
  • Phone: 501-224-1690
  • Fax: 501-224-1927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-554
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: