Healthcare Provider Details

I. General information

NPI: 1194647594
Provider Name (Legal Business Name): HALIE DODD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W VINE ST
SHERIDAN AR
72150-7703
US

IV. Provider business mailing address

800 W VINE ST
SHERIDAN AR
72150-7703
US

V. Phone/Fax

Practice location:
  • Phone: 870-942-3137
  • Fax:
Mailing address:
  • Phone: 870-942-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR106091
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: