Healthcare Provider Details

I. General information

NPI: 1043692080
Provider Name (Legal Business Name): MICHELLE LEIGH BAGBY DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 MARKET ST
PINE BLUFF AR
71601-6881
US

IV. Provider business mailing address

12446 PRINCETON PIKE
PINE BLUFF AR
71602-8566
US

V. Phone/Fax

Practice location:
  • Phone: 870-850-8200
  • Fax: 870-850-8424
Mailing address:
  • Phone: 870-209-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA004416
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004416
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: