Healthcare Provider Details

I. General information

NPI: 1033087648
Provider Name (Legal Business Name): BEVERLY ANN HALL CHILDCARE PROF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/30/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 20TH ST
NORTH LITTLE ROCK AR
72114-2812
US

IV. Provider business mailing address

200 W 20TH ST
NORTH LITTLE ROCK AR
72114-2812
US

V. Phone/Fax

Practice location:
  • Phone: 501-773-2594
  • Fax: 501-904-2392
Mailing address:
  • Phone: 501-773-2594
  • Fax: 501-904-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number20-0713835
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: