Provider Demographics
NPI:1518517010
Name:CARR, BENJAMIN (QBHP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:CARR
Suffix:
Gender:M
Credentials:QBHP
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:DAVID
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QBHP
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:2305 OLD COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4148
Practice Address - Country:US
Practice Address - Phone:870-892-1005
Practice Address - Fax:870-892-0078
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1537224Z00000X
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant