Active NPI
Mollie Gentry
- Speech-Language Pathologist
- Ward, AR
National Provider Identifier
1881740538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP2360
- Practice address
- 1500 Wilson Loop Road
Ward, AR 72176 - Phone
- (501) 941-5630
- NPI assigned
- Jan 26, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP2360 | AR | Primary |
Addresses
Primary practice location
1500 Wilson Loop Road
Ward, AR 72176
Mailing address
PO Box 333
Ward, AR 72176-0333
Phone (501) 912-1352
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5Y680 | Other | AR | BLUE CROSS & BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP2360 | AR | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Therapy and Consulting Services, PA | Current | Accepting new patients | |
| Beyond Boundaries, Inc | Speech-Language Pathologist | Past | Accepting new patients |
Locations
5532 John F Kennedy Blvd
North Little Rock, AR 72116
Phone (501) 588-3211
Organizations & group practices 2
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.
-
- Specialist
- North Little Rock, AR
- NPI 1134185937
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881740538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 333",
"city": "WARD",
"state": "AR",
"postal_code": "721760333",
"telephone_number": "501-912-1352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 WILSON LOOP ROAD",
"city": "WARD",
"state": "AR",
"postal_code": "72176",
"telephone_number": "501-941-5630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTRY",
"first_name": "MOLLIE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "SP2360",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "5Y680",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ward, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.