Healthcare Provider Details

I. General information

NPI: 1669423125
Provider Name (Legal Business Name): DONNA BERRYMAN BEALLIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W MAPLE AVE
SPRINGDALE AR
72764-5335
US

IV. Provider business mailing address

PO BOX 11134
FORT SMITH AR
72917-1134
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-5711
  • Fax:
Mailing address:
  • Phone: 479-806-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-5626
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberE-5626
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: