Healthcare Provider Details

I. General information

NPI: 1003557109
Provider Name (Legal Business Name): MAGGIE T BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 NORTHSHORE DR
NORTH LITTLE ROCK AR
72118-5293
US

IV. Provider business mailing address

4901 NORTHSHORE DR
NORTH LITTLE ROCK AR
72118-5293
US

V. Phone/Fax

Practice location:
  • Phone: 501-791-3331
  • Fax: 501-791-0294
Mailing address:
  • Phone: 501-791-3331
  • Fax: 501-791-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70124
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-195420
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: