Healthcare Provider Details

I. General information

NPI: 1487375622
Provider Name (Legal Business Name): GINGER LEANN HOLLOWAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W POPLAR ST
ROGERS AR
72756-4245
US

IV. Provider business mailing address

614 E EMMA AVE STE 300
SPRINGDALE AR
72764-4469
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9235
  • Fax: 479-751-2878
Mailing address:
  • Phone: 479-751-7417
  • Fax: 479-721-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number212815
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212815
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: