Healthcare Provider Details

I. General information

NPI: 1104323617
Provider Name (Legal Business Name): ALLISON BROOKE WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

4 LEVANT DR
LITTLE ROCK AR
72212-2658
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-5155
  • Fax:
Mailing address:
  • Phone: 501-680-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-16380
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-16380
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-16380
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: