Healthcare Provider Details

I. General information

NPI: 1912369687
Provider Name (Legal Business Name): MARY E RAWN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA RAWN APN

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR MEDICAL TOWERS I STE 750
LITTLE ROCK AR
72205-6321
US

IV. Provider business mailing address

2024 ARKANSAS VALLEY DR SUITE 202
LITTLE ROCK AR
72212-4166
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-0200
  • Fax:
Mailing address:
  • Phone: 501-227-0700
  • Fax: 501-227-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20960
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number20960
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number20960
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA004797
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberA004797
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: