Healthcare Provider Details

I. General information

NPI: 1003680125
Provider Name (Legal Business Name): TIFFANY TAGGART RILEY DNP, FNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TIFFANY AMBER TAGGART

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/05/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 860
LITTLE ROCK AR
72205-6375
US

IV. Provider business mailing address

4261 STOCKTON DR STE LL100
NORTH LITTLE ROCK AR
72117-2966
US

V. Phone/Fax

Practice location:
  • Phone: 501-975-7456
  • Fax: 501-978-1822
Mailing address:
  • Phone: 501-975-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number230675
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR107327
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: