Healthcare Provider Details

I. General information

NPI: 1255715348
Provider Name (Legal Business Name): MEAGAN CUPAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGAN WALKER APRN

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 CARTI WAY
LITTLE ROCK AR
72205-6523
US

IV. Provider business mailing address

2400 STATE FARM RD
TUCKER AR
72168-9503
US

V. Phone/Fax

Practice location:
  • Phone: 501-906-3000
  • Fax:
Mailing address:
  • Phone: 501-842-2519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004462
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: