MEDICARE: DR. MICHELLE MONFEE RANSOM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	E4477	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E4477	OTHER	AR	LICENSE NUMBER

General Provider Information

NPI Number	:	1699753061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MONFEE RANSOM M.D.

Provider Business Mailing Address
First Line	:	2200 FORT ROOTS DR
Second Line	:	1L MENTAL HEALTH CLINIC
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-1709
Country	:	US
Telephone Number	:	501-257-3169
Fax Number	:	501-257-3164

Provider Business Practice Location Address
First Line	:	2200 FORT ROOTS DR
Second Line	:	1L MENTAL HEALTH CLINIC
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-1709
Country	:	US
Telephone Number	:	501-257-3168
Fax Number	:	501-257-3164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/29/2013

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