Healthcare Provider Details

I. General information

NPI: 1063772606
Provider Name (Legal Business Name): FAROLYN DENISE MURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 W 34TH AVE
PINE BLUFF AR
71603-5508
US

IV. Provider business mailing address

1 CHILDRENS WAY SLOT 512-39
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-6067
  • Fax: 870-534-7297
Mailing address:
  • Phone: 501-364-3620
  • Fax: 501-364-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR44380
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: