Healthcare Provider Details

I. General information

NPI: 1497270771
Provider Name (Legal Business Name): EMILY K AVERILL NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 1200
LITTLE ROCK AR
72205-6334
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DR STE 1200
LITTLE ROCK AR
72205-6334
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4131
  • Fax: 501-975-1798
Mailing address:
  • Phone: 501-664-4131
  • Fax: 501-975-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005250
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: