Healthcare Provider Details

I. General information

NPI: 1255767653
Provider Name (Legal Business Name): LISA CULP HELD PONTIOUS CNM, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6119 MIDTOWN AVE
LITTLE ROCK AR
72205-5313
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-296-1800
  • Fax: 501-296-1711
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2013034503
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM002125
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number53-80752-112
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: