Provider Demographics
NPI:1417220526
Name:ULIBARRI, BENJAMIN B (PMHNP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:B
Last Name:ULIBARRI
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 NELMS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1006
Mailing Address - Country:US
Mailing Address - Phone:870-219-0812
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:1150 E MATTHEWS AVE STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4346
Practice Address - Country:US
Practice Address - Phone:870-243-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226393363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health