Healthcare Provider Details

I. General information

NPI: 1942124532
Provider Name (Legal Business Name): BREANNA COWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 RODEO DR
MOUNTAIN HOME AR
72653-4501
US

IV. Provider business mailing address

441 BOMBER BLVD
MOUNTAIN HOME AR
72653-4608
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-1201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number123637
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: