=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639208382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEN T WILKINS MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 02/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 S MAIN ST SUITE 200
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-6848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-279-0502
-----------------------------------------------------
Fax | 501-279-0506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 S MAIN ST SUITE 200
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-6848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-279-0502
-----------------------------------------------------
Fax | 501-279-0506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BEN T WILKINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 501-279-0502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | A03713
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | E3747
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------