Provider Demographics
NPI:1477290476
Name:BLACKWELL-EL, ARLINDA (HOLISTIC PRACTITIONE)
Entity Type:Individual
Prefix:
First Name:ARLINDA
Middle Name:
Last Name:BLACKWELL-EL
Suffix:
Gender:F
Credentials:HOLISTIC PRACTITIONE
Other - Prefix:
Other - First Name:ARLINDA
Other - Middle Name:
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HOLISTIC PRACTITIONE
Mailing Address - Street 1:2200 MEADOWLAKE RD APT 413
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2548
Mailing Address - Country:US
Mailing Address - Phone:607-760-9608
Mailing Address - Fax:
Practice Address - Street 1:832 CHESTNUT ST STE 102
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5434
Practice Address - Country:US
Practice Address - Phone:501-205-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1497492219OtherLLRCNH
AR15579922OtherCAQH