Healthcare Provider Details

I. General information

NPI: 1578892097
Provider Name (Legal Business Name): PHYSICIAN'S SLEEP CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 DUSTY LAKE DR SUITE 204
PINE BLUFF AR
71603-8742
US

IV. Provider business mailing address

1801 W 40TH AVE SUITE 5 B
PINE BLUFF AR
71603-6940
US

V. Phone/Fax

Practice location:
  • Phone: 870-879-6571
  • Fax:
Mailing address:
  • Phone: 870-535-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELYN SUE FRIGON
Title or Position: OWNER
Credential: M.D.
Phone: 870-535-4800