Healthcare Provider Details

I. General information

NPI: 1083909295
Provider Name (Legal Business Name): COMPLETE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 GEYER SPRINGS RD SUITE 1-S
LITTLE ROCK AR
72209-2727
US

IV. Provider business mailing address

6917 GEYER SPRINGS RD SUITE 1-S
LITTLE ROCK AR
72209-2727
US

V. Phone/Fax

Practice location:
  • Phone: 501-570-4004
  • Fax:
Mailing address:
  • Phone: 501-570-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2385
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2013
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1949
License Number StateAR

VIII. Authorized Official

Name: MISS LAURA JENNINGS
Title or Position: OWNER
Credential:
Phone: 501-837-7216