Provider Demographics
NPI:1265154272
Name:NATURAL STATE IVY
Entity type:Organization
Organization Name:NATURAL STATE IVY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:COLBY
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:501-208-7037
Mailing Address - Street 1:301 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-4918
Mailing Address - Country:US
Mailing Address - Phone:501-208-7037
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-4918
Practice Address - Country:US
Practice Address - Phone:501-621-2442
Practice Address - Fax:501-687-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty