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General NPI Number Information
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NPI Number | 1558809475
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Entity Type | Individual
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Provider Name | BROCK HARRISON WRINKLES PA
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Gender | Male
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Dates
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Enumeration Date | 02/11/2017
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 1801 CENTRAL AVE STE A
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City | HOT SPRINGS
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State | AR
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Zip | 71901-6800
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Country | US
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Telephone | 501-623-5598
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Fax | 501-623-5516
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Provider Business Mailing Address
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Address Line | 6 TRENT JONES CV
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City | SHERWOOD
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State | AR
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Zip | 72120-4611
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Country | US
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Telephone | 501-599-8400
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Fax | 501-623-5598
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PT2017-010
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | PA-720
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License Number State | AR
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