Healthcare Provider Details

I. General information

NPI: 1518335587
Provider Name (Legal Business Name): HANNAH BLAYLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11607 MAUMELLE BLVD
NORTH LITTLE ROCK AR
72113-6529
US

IV. Provider business mailing address

11607 MAUMELLE BLVD
NORTH LITTLE ROCK AR
72113-6529
US

V. Phone/Fax

Practice location:
  • Phone: 501-441-3735
  • Fax: 501-443-3789
Mailing address:
  • Phone: 501-441-3735
  • Fax: 501-443-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004516
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: