Healthcare Provider Details

I. General information

NPI: 1639208382
Provider Name (Legal Business Name): BEN T WILKINS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST SUITE 200
SEARCY AR
72143-6848
US

IV. Provider business mailing address

400 S MAIN ST SUITE 200
SEARCY AR
72143-6848
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-0502
  • Fax: 501-279-0506
Mailing address:
  • Phone: 501-279-0502
  • Fax: 501-279-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE3747
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA03713
License Number StateAR

VIII. Authorized Official

Name: DR. BEN T WILKINS
Title or Position: PRESIDENT
Credential: MD
Phone: 501-279-0502