Healthcare Provider Details

I. General information

NPI: 1841595386
Provider Name (Legal Business Name): HOLLY N GRIFFIS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N FOURCHE AVE
PERRYVILLE AR
72126
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR SUITE 200
LITTLE ROCK AR
72211-4316
US

V. Phone/Fax

Practice location:
  • Phone: 501-889-5543
  • Fax:
Mailing address:
  • Phone: 501-812-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberT 0000
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: