Healthcare Provider Details

I. General information

NPI: 1821409996
Provider Name (Legal Business Name): CRYSTAL LITTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W 42ND AVE
PINE BLUFF AR
71603-7018
US

IV. Provider business mailing address

1 CHILDRENS WAY # 844
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 870-556-7000
  • Fax: 870-556-7019
Mailing address:
  • Phone: 501-364-2090
  • Fax: 501-364-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-9336
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: