Healthcare Provider Details

I. General information

NPI: 1730331638
Provider Name (Legal Business Name): ELLA L WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 W 12TH ST
LITTLE ROCK AR
72202-4551
US

IV. Provider business mailing address

800 MARSHALL ST SLOT 900
LITTLE ROCK AR
72202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-7510
  • Fax: 501-364-5194
Mailing address:
  • Phone: 501-364-3620
  • Fax: 501-364-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: