Healthcare Provider Details

I. General information

NPI: 1255853107
Provider Name (Legal Business Name): PATRICIA ANN CASTLEBERRY MSE-ECSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 COLONEL GLENN RD
LITTLE ROCK AR
72204-7503
US

IV. Provider business mailing address

13 LAKE FOREST DR
MAYFLOWER AR
72106-9568
US

V. Phone/Fax

Practice location:
  • Phone: 501-280-9195
  • Fax: 501-664-2488
Mailing address:
  • Phone: 501-733-9728
  • Fax: 501-664-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: