Healthcare Provider Details

I. General information

NPI: 1497567978
Provider Name (Legal Business Name): SYDNIE PELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CORRECTIONS DR
NEWPORT AR
72112-8008
US

IV. Provider business mailing address

22 COUGAR RD
SULPHUR ROCK AR
72579-9406
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-3808
  • Fax: 870-300-1090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01250457
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: