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General NPI Number Information
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NPI Number | 1063144798
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Entity Type | Individual
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Provider Name | BAILEY J TADLOCK PA
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Gender | Female
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 801 COTTAGE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5400
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Country | US
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Telephone | 501-686-6067
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Fax | 501-526-5148
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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Fax | 501-526-5148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1307
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License Number State | AR
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