Healthcare Provider Details

I. General information

NPI: 1649792995
Provider Name (Legal Business Name): BRANDY HUDDLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 E EMMA AVE
SPRINGDALE AR
72764-4503
US

IV. Provider business mailing address

602 N WALTON BLVD
BENTONVILLE AR
72712-4576
US

V. Phone/Fax

Practice location:
  • Phone: 479-770-0788
  • Fax:
Mailing address:
  • Phone: 479-464-1060
  • Fax: 479-271-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-A2194
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: