Healthcare Provider Details

I. General information

NPI: 1376388397
Provider Name (Legal Business Name): SYDNEY SKAGGS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 JFK BLVD STE G
NORTH LITTLE ROCK AR
72116-6740
US

IV. Provider business mailing address

5401 JFK BLVD STE G
NORTH LITTLE ROCK AR
72116-6740
US

V. Phone/Fax

Practice location:
  • Phone: 501-528-3291
  • Fax: 501-285-9241
Mailing address:
  • Phone: 501-528-3291
  • Fax: 501-285-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number202258
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: