Provider Demographics
NPI:1912369687
Name:RAWN, MARY E (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:RAWN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:RAWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:2024 ARKANSAS VALLEY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4166
Mailing Address - Country:US
Mailing Address - Phone:501-227-0700
Mailing Address - Fax:501-227-0744
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:MEDICAL TOWERS I STE 750
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-224-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20960363LA2200X, 363LG0600X, 363LP2300X
ARA004797363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care