Healthcare Provider Details

I. General information

NPI: 1225870306
Provider Name (Legal Business Name): PHILANDER SMITH UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W DAISY L GATSON BATES DR
LITTLE ROCK AR
72202-3726
US

IV. Provider business mailing address

900 W DAISY L GATSON BATES DR
LITTLE ROCK AR
72202-3726
US

V. Phone/Fax

Practice location:
  • Phone: 501-370-5333
  • Fax:
Mailing address:
  • Phone: 501-370-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEVETA CROUTHER
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 501-370-5333