Healthcare Provider Details

I. General information

NPI: 1871913970
Provider Name (Legal Business Name): WHITNEY PHILAMLEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 HIGHWAY 65 S STE 202
CLINTON AR
72031-6678
US

IV. Provider business mailing address

2526 HIGHWAY 65 S STE 202
CLINTON AR
72031-6678
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-2122
  • Fax:
Mailing address:
  • Phone: 501-745-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE11667
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE11667
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: