Healthcare Provider Details

I. General information

NPI: 1356981641
Provider Name (Legal Business Name): NORTH ARKANSAS REGENERATIVE MEDICINE LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2988 W HUNTSVILLE AVE STE C
SPRINGDALE AR
72762-7739
US

IV. Provider business mailing address

2988 W HUNTSVILLE AVE STE C
SPRINGDALE AR
72762-7739
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-0190
  • Fax: 479-751-6011
Mailing address:
  • Phone: 479-751-0190
  • Fax: 479-751-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEAH M CARRINGTON
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 479-757-0190