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General NPI Number Information
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NPI Number | 1417445180
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Entity Type | Individual
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Provider Name | KATIE CLARK WADLINGTON MD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 5921 RILEY PARK DR
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City | FORT SMITH
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State | AR
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Zip | 72916-6103
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Country | US
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Telephone | 479-649-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 7108 FOREST CANYON DR
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City | FORT SMITH
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State | AR
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Zip | 72916-4078
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Country | US
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Telephone | 318-243-7458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | E-15363
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License Number State | AR
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