Healthcare Provider Details

I. General information

NPI: 1659508828
Provider Name (Legal Business Name): PDB ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10402 STAGECOACH ROAD SUITE G
LLITTLE ROCK AR
72210-8986
US

IV. Provider business mailing address

PO BOX 30220
LITTLE ROCK AR
72260-0005
US

V. Phone/Fax

Practice location:
  • Phone: 501-455-0950
  • Fax: 501-455-4065
Mailing address:
  • Phone: 501-455-0950
  • Fax: 501-455-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberBL00034171
License Number StateAR

VIII. Authorized Official

Name: MS. PATRICIA DODSON BROWN
Title or Position: CEO
Credential: RN, CCM, CLCP
Phone: 501-455-0950