Healthcare Provider Details

I. General information

NPI: 1609837459
Provider Name (Legal Business Name): ARKANSAS ALLERGY & ASTHMA CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SALEM RD SUITE 4
CONWAY AR
72034-6162
US

IV. Provider business mailing address

400 SALEM RD SUITE 4
CONWAY AR
72034-6162
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-0237
  • Fax: 501-932-0565
Mailing address:
  • Phone: 501-329-0237
  • Fax: 501-932-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY PRINCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-329-0237