Healthcare Provider Details

I. General information

NPI: 1811471204
Provider Name (Legal Business Name): MARK ALEXANDER MCKOOL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 OAKWOOD AVE
BENTONVILLE AR
72712-4024
US

IV. Provider business mailing address

2001 OAKWOOD AVE
BENTONVILLE AR
72712-4024
US

V. Phone/Fax

Practice location:
  • Phone: 469-203-6051
  • Fax:
Mailing address:
  • Phone: 469-203-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65750
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: