Healthcare Provider Details

I. General information

NPI: 1811470115
Provider Name (Legal Business Name): PAIGE JORDAN BIGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 HIGHWAY 365 STE 3
MAYFLOWER AR
72106-9525
US

IV. Provider business mailing address

879 CROSSTRAILS RD
DE QUEEN AR
71832-9210
US

V. Phone/Fax

Practice location:
  • Phone: 501-470-3500
  • Fax:
Mailing address:
  • Phone: 870-784-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTR3907
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: