Healthcare Provider Details

I. General information

NPI: 1821918103
Provider Name (Legal Business Name): ALEXIS TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 BATESVILLE BLVD
SOUTHSIDE AR
72501-7894
US

IV. Provider business mailing address

1290 NEWPORT RD
BATESVILLE AR
72501-9705
US

V. Phone/Fax

Practice location:
  • Phone: 870-701-5089
  • Fax: 870-277-0896
Mailing address:
  • Phone: 870-805-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA5127
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: