Healthcare Provider Details

I. General information

NPI: 1649545195
Provider Name (Legal Business Name): NEPHROPATHOLOGY ASSOCIATES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 EXECUTIVE CENTER DR SUITE 100
LITTLE ROCK AR
72211-4386
US

IV. Provider business mailing address

10810 EXECUTIVE CENTER DR SUITE 100
LITTLE ROCK AR
72211-4386
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-2695
  • Fax: 501-604-2699
Mailing address:
  • Phone: 501-604-2695
  • Fax: 501-604-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PATRICK LARSEN
Title or Position: EXECUTIVE DIRECTOR, OWNER
Credential: MD
Phone: 501-604-2695