Healthcare Provider Details

I. General information

NPI: 1306183272
Provider Name (Legal Business Name): KIMBERLY ROCHELLE PARKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MANNING LMSW

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR RM 111
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

2724 OPAL CV
SHERWOOD AR
72120-2381
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1484
  • Fax: 501-257-1421
Mailing address:
  • Phone: 501-606-4711
  • Fax: 501-257-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: