=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265350243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORIAN GRAYSON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 S BOWMAN RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-4136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-558-4100
-----------------------------------------------------
Fax | 501-558-4101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 S PORTER ST
-----------------------------------------------------
City | STUTTGART
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72160-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-558-4100
-----------------------------------------------------
Fax | 501-558-4101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 238471
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------