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General NPI Number Information
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NPI Number | 1649538679
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Entity Type | Individual
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Provider Name | KATIE JANETTE CARILLON P.A.C.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 1701 CLUB MANOR DR STE 2B
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City | MAUMELLE
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State | AR
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Zip | 72113-7401
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Country | US
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Telephone | 501-843-4555
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Fax | 501-743-1550
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Provider Business Mailing Address
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Address Line | 11001 EXECUTIVE CENTER DR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4393
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Country | US
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Telephone | 501-851-7402
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Fax | 501-851-4753
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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 | PA468
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License Number State | AR
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