Healthcare Provider Details

I. General information

NPI: 1700718319
Provider Name (Legal Business Name): LAINEY ELIZABETH BIVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 52ND ST
ROGERS AR
72758-8637
US

IV. Provider business mailing address

4532 STONECREST
SPRINGDALE AR
72762-8103
US

V. Phone/Fax

Practice location:
  • Phone: 877-505-2276
  • Fax:
Mailing address:
  • Phone: 479-502-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: