Healthcare Provider Details

I. General information

NPI: 1043660533
Provider Name (Legal Business Name): STARRY TAYLOR HUBBELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STARRY DALENE TAYLOR APRN

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2708 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3030
  • Fax:
Mailing address:
  • Phone: 479-338-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA004766
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: