Healthcare Provider Details

I. General information

NPI: 1699586651
Provider Name (Legal Business Name): RYVER BARHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 HALBERT ST
MALVERN AR
72104-2607
US

IV. Provider business mailing address

108 VISTA AVE
HOT SPRINGS AR
71901-7020
US

V. Phone/Fax

Practice location:
  • Phone: 501-332-4400
  • Fax:
Mailing address:
  • Phone: 501-332-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: