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General NPI Number Information
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NPI Number | 1649006941
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Entity Type | Organization
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Legal Business Name | ROOTED HEALTH HORMONES & MEDSPA LLC
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 1120 HOGAN LN
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City | CONWAY
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State | AR
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Zip | 72034-8119
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Country | US
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Telephone | 501-261-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 HOGAN LN STE B2
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City | CONWAY
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State | AR
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Zip | 72034-8216
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Country | US
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Telephone | 479-880-6148
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Fax | 479-765-1396
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Authorized Official
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Title or Position | OWNER
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Name | LADONNA WALKER
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Credential | APRN
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Telephone | 479-880-6148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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