Healthcare Provider Details

I. General information

NPI: 1104696186
Provider Name (Legal Business Name): ALYSSA HAULCROFT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MCLAIN ST STE B
NEWPORT AR
72112-3550
US

IV. Provider business mailing address

1200 MCLAIN ST STE B
NEWPORT AR
72112-3550
US

V. Phone/Fax

Practice location:
  • Phone: 870-532-2320
  • Fax: 870-532-8891
Mailing address:
  • Phone: 870-523-2320
  • Fax: 870-523-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226525
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: