Healthcare Provider Details

I. General information

NPI: 1649913880
Provider Name (Legal Business Name): NADIA V. MAKKOUKDJI DEPSILLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CHILDRENS WAY # 512-13
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

13 CHILDRENS WAY # 512-13
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-19637
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: