Healthcare Provider Details

I. General information

NPI: 1134004047
Provider Name (Legal Business Name): LOLITA CHAVEZ HACKWORTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 JOHNSON DR
SHERWOOD AR
72120-8025
US

IV. Provider business mailing address

125 HUDSON BRANCH DR
AUSTIN AR
72007-9719
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-6655
  • Fax:
Mailing address:
  • Phone: 580-339-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number234542
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: