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General NPI Number Information
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NPI Number | 1427061175
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE WONG MD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 28 W SUNBRIDGE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-301-2284
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Fax | 479-301-2338
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Provider Business Mailing Address
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Address Line | 28 W SUNBRIDGE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-301-2284
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Fax | 479-301-2338
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | K9457
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E4225
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License Number State | AR
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