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General NPI Number Information
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NPI Number | 1427833219
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Entity Type | Organization
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Legal Business Name | KIDSPOT JACKSON COUNTY INC
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 6309 HIGHWAY 367 N
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City | TUCKERMAN
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State | AR
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Zip | 72473-9389
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Country | US
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Telephone | 870-495-3124
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Fax | 870-495-3029
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Provider Business Mailing Address
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Address Line | 6309 HIGHWAY 367 N
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City | TUCKERMAN
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State | AR
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Zip | 72473-9389
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Country | US
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Telephone | 870-495-3124
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Fax | 870-495-3029
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Authorized Official
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Title or Position | OWNER
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Name | SHELLY TUCKER
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Credential |
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Telephone | 870-930-5832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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