NPIMap

Individual provider Active NPI

Abigail Grace Connerly, APRN

  • Nurse Practitioner
  • Little Rock, AR
National Provider Identifier
1104476720
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A006121 Issued in AR
Practice address
7 Shackleford West Blvd
Little Rock, AR 72211-3886
Phone
(501) 664-5860
Fax
(501) 664-0889
NPI assigned
Sep 16, 2019
Last updated
Sep 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A006121 AR Primary

Addresses

Primary practice location

7 Shackleford West Blvd
Little Rock, AR 72211-3886

Mailing address

7 Shackleford West Blvd
Little Rock, AR 72211-3886
Phone (501) 664-5860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191018001118 AR Practitioner - Nurse Practitioner 3375874597 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arkansas Heart Hospital LLCGroup PAC ID 6002838653, 85 clinicians
Arkansas Heart Hospital Rural Health Services, LLCGroup PAC ID 6204004815, 52 clinicians

Practice addresses (Care Compare)

7 Shackleford W Blvd
Little Rock, AR 72211-3886
Phone (501) 664-5860

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A006121ARMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas Heart Hospital Rural Health Services, LLC CurrentSince Sep 9, 2019 Accepting new patients
Arkansas Heart Hospital, LLC CurrentSince Sep 9, 2019 Accepting new patients
Arkansas Heart Hospital, LLC CurrentSince Sep 9, 2019 Accepting new patients

Locations

605 Dave Ward Dr
Ste 105
Conway, AR 72034
Phone (501) 504-6270

7 Shackleford West Blvd
Little Rock, AR 72211
Phone (501) 614-3671

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1104476720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 SHACKLEFORD WEST BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113886",
            "telephone_number": "501-664-5860",
            "fax_number": "501-664-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 SHACKLEFORD WEST BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113886",
            "telephone_number": "501-664-5860",
            "fax_number": "501-664-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNERLY",
        "first_name": "ABIGAIL",
        "middle_name": "GRACE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A006121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.