=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235248246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ANTHONY PIPPENGER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 SPRINGHILL DR STE 490A
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72117-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-202-3815
-----------------------------------------------------
Fax | 501-202-3835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11001 EXECUTIVE CENTER DR STE 200
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-404-3785
-----------------------------------------------------
Fax | 501-404-3789
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084B0040X
-----------------------------------------------------
Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
-----------------------------------------------------
License Number | E-3021
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | E-3021
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------