Healthcare Provider Details

I. General information

NPI: 1629536461
Provider Name (Legal Business Name): SOUTH ARKANSAS CHILDRENS COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E MAIN ST
EL DORADO AR
71730-6324
US

IV. Provider business mailing address

1154 SOUTHFIELD CUTOFF
EL DORADO AR
71730-3451
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-2272
  • Fax: 870-862-2276
Mailing address:
  • Phone: 870-562-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KARRAH CLARK
Title or Position: MEDICAL EXAMINER
Credential: APRN, CPNP-PC
Phone: 870-562-3392