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General NPI Number Information
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NPI Number | 1629536461
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Entity Type | Organization
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Legal Business Name | SOUTH ARKANSAS CHILDRENS COALITION
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 1130 E MAIN ST
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City | EL DORADO
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State | AR
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Zip | 71730-6324
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Country | US
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Telephone | 870-862-2272
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Fax | 870-862-2276
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Provider Business Mailing Address
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Address Line | 1154 SOUTHFIELD CUTOFF
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City | EL DORADO
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State | AR
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Zip | 71730-3451
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Country | US
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Telephone | 870-562-3392
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Fax |
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Authorized Official
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Title or Position | MEDICAL EXAMINER
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Name | KARRAH CLARK
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Credential | APRN, CPNP-PC
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Telephone | 870-562-3392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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