Healthcare Provider Details
I. General information
NPI: 1447275656
Provider Name (Legal Business Name): KAREN KUO PECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/12/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
333 RED WOLF BLVD
JONESBORO AR
72405-9739
US
IV. Provider business mailing address
1001 COUNTY ROAD 759
JONESBORO AR
72405-7742
US
V. Phone/Fax
- Phone: 870-933-1823
- Fax:
- Phone: 870-268-1377
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207PE0004X |
| Taxonomy | Emergency Medical Services (Emergency Medicine) Physician |
| License Number | E4020 |
| License Number State | AR |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: