Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003364563 |
---|---|
Provider Name | Angela Braggs |
First Address | Little Rock, AR 72223-6103 |
Second Address | Little Rock, AR 72223-6103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2016 |
Last Update Date | 15/09/2016 |