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General NPI Number Information
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NPI Number | 1578191383
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Entity Type | Individual
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Provider Name | DAVID KEITH WILSON II DO
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Gender | Male
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Dates
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Enumeration Date | 03/28/2020
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1 CHILDRENS WAY # 512-1
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3500
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Country | US
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Telephone | 501-364-1874
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Fax | 501-364-5148
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Provider Business Mailing Address
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Address Line | 1 CHILDRENS WAY # 653
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3500
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Country | US
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Telephone | 501-364-1100
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Fax | 501-526-5148
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-17127
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License Number State | AR
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