Healthcare Provider Details

I. General information

NPI: 1740013739
Provider Name (Legal Business Name): DR WHALEY PAIN MANAGEMENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E MICHIGAN ST
STUTTGART AR
72160-3269
US

IV. Provider business mailing address

PO BOX 55990
LITTLE ROCK AR
72215-5990
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-0700
  • Fax: 501-227-0744
Mailing address:
  • Phone: 501-227-0700
  • Fax: 501-227-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER WHALEY
Title or Position: OWNER
Credential: MD
Phone: 501-554-6005