CHANGE CENTER FOR VITALITY NPI 1720390362

NPI Information

  • NPI: 1720390362
  • Provider Name: CHANGE CENTER FOR VITALITY
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 04D1079751
  • Address: 400 W CAPITOL AVE
    STE 100D
    LITTLE ROCK, AR
    ZIP 72201
  • Phone: (501) 324-2649

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NPI Details

CHANGE CENTER FOR VITALITY is a family nurse practitioner in Little Rock, AR. CHANGE CENTER FOR VITALITY NPI is 1720390362. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

400 W CAPITOL AVE
STE 100D
LITTLE ROCK, AR
ZIP 72201-436
Phone: (501) 324-2649

The provider's authorized official is Debra Velez .
The authorized official title is President and has the following contact phone number (501) 324-8649.

The CLIA number assigned to this NPI record is 04D1079751 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/12/2010 and was last updated on 7/12/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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