Healthcare Provider Details

I. General information

NPI: 1356978142
Provider Name (Legal Business Name): IJANAE HOLMAN-ALLGOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 JOHN F KENNEDY BLVD
NORTH LITTLE ROCK AR
72116-7310
US

IV. Provider business mailing address

4625 JFK BLVD
NORTH LITTLE ROCK AR
72116-7310
US

V. Phone/Fax

Practice location:
  • Phone: 501-435-3455
  • Fax: 501-483-3630
Mailing address:
  • Phone: 501-435-3455
  • Fax: 501-483-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-16169
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: