Healthcare Provider Details

I. General information

NPI: 1982687471
Provider Name (Legal Business Name): ANDREA S BREEDLOVE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA S BREEDLOVE APRN

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9712 W MARKHAM ST
LITTLE ROCK AR
72205-2124
US

IV. Provider business mailing address

9712 W MARKHAM ST
LITTLE ROCK AR
72205-2124
US

V. Phone/Fax

Practice location:
  • Phone: 501-280-0499
  • Fax: 501-217-0222
Mailing address:
  • Phone: 501-280-0499
  • Fax: 501-217-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberA001719
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA001719
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: