Healthcare Provider Details

I. General information

NPI: 1811494974
Provider Name (Legal Business Name): JHEANELLE DAWKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E KIEHL AVE
SHERWOOD AR
72120-3040
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-0703
  • Fax: 501-833-1716
Mailing address:
  • Phone: 18-350-7035
  • Fax: 501-833-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberE-12767
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: