Healthcare Provider Details

I. General information

NPI: 1518875095
Provider Name (Legal Business Name): BLOOM HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 JOHN F KENNEDY BLVD STE B
NORTH LITTLE ROCK AR
72116-8230
US

IV. Provider business mailing address

4137 JOHN F KENNEDY BLVD STE B
NORTH LITTLE ROCK AR
72116-8230
US

V. Phone/Fax

Practice location:
  • Phone: 501-909-5919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAUN LEAHAN RAY
Title or Position: OWNER
Credential: FNP-C
Phone: 501-909-5919