Healthcare Provider Details

I. General information

NPI: 1790754406
Provider Name (Legal Business Name): ARKANSAS NEUROPSYCHOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 INNWOOD CIRCLE STE 111
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

3 INNWOOD CR., STE 111
LITTLE ROCK AR
72211
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-1050
  • Fax: 888-684-7266
Mailing address:
  • Phone: 501-664-1050
  • Fax: 888-684-7266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number86-21P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateAR

VIII. Authorized Official

Name: ELIZABETH SPECK-KERN
Title or Position: OWNER
Credential: PHD
Phone: 501-664-1050