Healthcare Provider Details

I. General information

NPI: 1316858822
Provider Name (Legal Business Name): BRONWYNE BAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 RAHLING RD APT 1203
LITTLE ROCK AR
72223-5276
US

IV. Provider business mailing address

701 RAHLING RD APT 1203
LITTLE ROCK AR
72223-5276
US

V. Phone/Fax

Practice location:
  • Phone: 662-604-0175
  • Fax:
Mailing address:
  • Phone: 662-604-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI23691
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: