Healthcare Provider Details

I. General information

NPI: 1053006106
Provider Name (Legal Business Name): EMNET AKLILU MULUGETA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E. WASHINGTON AVE JONESBORO
JONESBORO AR
72401
US

IV. Provider business mailing address

225 E. WASHINGTON AVE JONESBORO,
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-1605
  • Fax: 870-207-0555
Mailing address:
  • Phone: 870-207-1605
  • Fax: 870-207-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-20243
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: