Healthcare Provider Details

I. General information

NPI: 1972486892
Provider Name (Legal Business Name): EMILY FAITH PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N WOODS LN
ROGERS AR
72756-6712
US

IV. Provider business mailing address

2717 ELLIOTT ST
PEA RIDGE AR
72751
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-3190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12690417
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: