Healthcare Provider Details

I. General information

NPI: 1477516417
Provider Name (Legal Business Name): ARKANSAS PEDIATRICS OF CONWAY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 COLLEGE AVE
CONWAY AR
72034-6141
US

IV. Provider business mailing address

PO BOX 1210
CONWAY AR
72033-1210
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-1800
  • Fax: 501-329-2507
Mailing address:
  • Phone: 501-329-1800
  • Fax: 501-329-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMC1605
License Number StateAR

VIII. Authorized Official

Name: MRS. DONNA M. STRICKLAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-329-1800