Healthcare Provider Details

I. General information

NPI: 1932737244
Provider Name (Legal Business Name): HOLLY MARIE TENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 300
NORTH LITTLE ROCK AR
72117-2909
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-4132
  • Fax:
Mailing address:
  • Phone: 501-753-4172
  • Fax: 501-753-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-16884
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: