Healthcare Provider Details

I. General information

NPI: 1063049401
Provider Name (Legal Business Name): JONATHAN T SPRADLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 400
NORTH LITTLE ROCK AR
72117-2008
US

IV. Provider business mailing address

3201 SPRINGHILL DR STE 400
NORTH LITTLE ROCK AR
72117-2008
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-8838
  • Fax:
Mailing address:
  • Phone: 504-988-8838
  • Fax: 504-988-8835

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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-19201
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number328225
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberE-19201
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: