Cordell Weston Crisp, MD
Individual provider Active NPI Internal Medicine Physician · Little Rock, AR
NPI 1730768243 · NPPES record last updated May 27, 2026
Key facts
- NPI
- 1730768243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- E-19215 (AR)
- Practice address
- 4301 W Markham St
Little Rock, AR 72205-7199 - Phone
- (501) 686-5162
- NPI assigned
- Apr 3, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210614000174 | AR | Order and Referring Only - Pediatric Medicine |
4880094861 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-19215 | AR | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | E-19215 | AR | Yes |
Addresses
Primary practice location
4301 W Markham St
Little Rock, AR 72205-7199
Mailing address
40 Ross Dr
Vilonia, AR 72173-9040
Phone (501) 283-0280
Other practice location 1
1 Childrens Way
Little Rock, AR 72202-3500
Phone (501) 686-5162
Other practice location 2
2200 Fort Roots Dr
North Little Rock, AR 72114-1709
Phone (501) 257-1000
Other providers in Little Rock, AR
- Jessica Cress
- Ariana R Crews
- Kyarra Crigler
- Jerry Criley
- Luminita Sanda Crisan
- Erica Nicole Criswell
- Lauren Criswell
- Rachel Crites
- Carol Crittendon
- Angela Critton
All providers in Little Rock, AR · Internal Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.