Healthcare Provider Details

I. General information

NPI: 1720666183
Provider Name (Legal Business Name): KATHLEEN MARIE JOHNSTONBAUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 508
LITTLE ROCK AR
72205-7199
US

IV. Provider business mailing address

147 CHARLES THOMAS BLVD
SEARCY AR
72143-8943
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax: 501-526-5148
Mailing address:
  • Phone: 602-752-0747
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-17580
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE-17580
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: