Healthcare Provider Details

I. General information

NPI: 1265095277
Provider Name (Legal Business Name): SUMMER LYNN MOJICA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 490A
NORTH LITTLE ROCK AR
72117-2910
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 501-404-3785
  • Fax: 501-404-3789
Mailing address:
  • Phone: 501-404-3785
  • Fax: 501-404-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-844
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-844
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: