Healthcare Provider Details

I. General information

NPI: 1750871570
Provider Name (Legal Business Name): GINGER RAE HART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

10100 KANIS RD
LITTLE ROCK AR
72205-6202
US

V. Phone/Fax

Practice location:
  • Phone: 501-908-0954
  • Fax:
Mailing address:
  • Phone: 501-255-6000
  • Fax: 501-255-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA005557
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: