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General NPI Number Information
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NPI Number | 1639970783
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Entity Type | Individual
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Provider Name | RAVENSYMONE FREEMAN
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 4619 W 25TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72204-5224
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Country | US
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Telephone | 501-298-0491
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Fax | 501-298-0491
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Provider Business Mailing Address
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Address Line | 4619 W 25TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72204-5224
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Country | US
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Telephone | 501-449-1588
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Fax | 501-449-1588
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 940260790
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License Number State | AR
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