Provider Demographics
NPI:1790933513
Name:BUXTON, CHARL Y (WHNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:CHARL
Middle Name:Y
Last Name:BUXTON
Suffix:
Gender:F
Credentials:WHNP, PMHNP
Other - Prefix:
Other - First Name:CHARL
Other - Middle Name:Y
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10025 W MARKHAM ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2178
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-661-1812
Practice Address - Street 1:10025 W MARKHAM ST STE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2178
Practice Address - Country:US
Practice Address - Phone:501-663-5473
Practice Address - Fax:501-661-1812
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601018T163W00000X
TX601018163WW0101X
ARA03582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHOL1-0433-8041OtherNCC