Healthcare Provider Details

I. General information

NPI: 1154959559
Provider Name (Legal Business Name): RACHEL ANNE MEVISSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 05/13/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 CHENAL PKWY STE 101
LITTLE ROCK AR
72211-5262
US

IV. Provider business mailing address

500 JANALYN CIR
GOLDEN VALLEY MN
55416-3327
US

V. Phone/Fax

Practice location:
  • Phone: 501-251-1733
  • Fax:
Mailing address:
  • Phone: 763-486-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-17498
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: