Provider Demographics
NPI:1366410516
Name:PRATHER, ANN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:PRATHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5242
Mailing Address - Country:US
Mailing Address - Phone:501-296-9220
Mailing Address - Fax:501-296-9984
Practice Address - Street 1:1501 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5242
Practice Address - Country:US
Practice Address - Phone:501-296-9220
Practice Address - Fax:501-296-9984
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR95-25P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T126OtherAR BLUE CROSS BLUE SHIELD