Healthcare Provider Details

I. General information

NPI: 1669581526
Provider Name (Legal Business Name): PULTRO AND PALMER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE SUITE 405
LITTLE ROCK AR
72205-5302
US

IV. Provider business mailing address

13815 HAROLD DR
ALEXANDER AR
72002-7293
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-5511
  • Fax: 501-664-5149
Mailing address:
  • Phone: 501-407-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA#270
License Number StateAR

VIII. Authorized Official

Name: MRS. TRACY MARIE VAN ES
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 501-626-9606