Healthcare Provider Details

I. General information

NPI: 1053090621
Provider Name (Legal Business Name): MCKENLEIGH N TERRY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENLEIGH N HILL

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 512-5
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1244
  • Fax: 501-364-4082
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number225511
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: