Healthcare Provider Details

I. General information

NPI: 1083285985
Provider Name (Legal Business Name): AUTONOMY HEALTH CARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 DOCTORS DR
PINE BLUFF AR
71603-7015
US

IV. Provider business mailing address

1700 DOCTORS DR
PINE BLUFF AR
71603-7015
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-2900
  • Fax: 501-207-8925
Mailing address:
  • Phone: 870-534-2900
  • Fax: 501-207-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THERESA ANN LYBRAND
Title or Position: OWNER
Credential:
Phone: 501-765-9214