Healthcare Provider Details

I. General information

NPI: 1386193407
Provider Name (Legal Business Name): ASHLEIGH G VANBLARCOM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-0200
  • Fax: 479-986-3448
Mailing address:
  • Phone: 479-636-0200
  • Fax: 479-986-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024174061
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number227298
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704285996
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: