Healthcare Provider Details

I. General information

NPI: 1366471195
Provider Name (Legal Business Name): ARKANSAS PEDIATRIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 317
LITTLE ROCK AR
72205-5342
US

IV. Provider business mailing address

16115 SAINT VINCENT WAY STE 320
LITTLE ROCK AR
72223-3000
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4117
  • Fax: 501-664-1137
Mailing address:
  • Phone: 501-664-4117
  • Fax: 501-664-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA PARSONS
Title or Position: ADMIN
Credential:
Phone: 501-664-4117