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General NPI Number Information
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NPI Number | 1699741033
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Entity Type | Organization
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Legal Business Name | ARKADELPHIA CLINIC FOR CHILDREN AND YOUNG ADULTS, PA
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Dates
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Enumeration Date | 02/26/2006
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 2850 TWIN RIVERS DR
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City | ARKADELPHIA
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State | AR
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Zip | 71923-4212
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Country | US
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Telephone | 870-246-8036
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Fax | 870-246-7164
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Provider Business Mailing Address
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Address Line | 2850 TWIN RIVERS DR
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City | ARKADELPHIA
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State | AR
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Zip | 71923-4212
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Country | US
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Telephone | 870-246-8036
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Fax | 870-246-7164
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WESLEY KLUCK
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Credential | M.D.
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Telephone | 870-246-8036
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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 | MC-1864
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License Number State | AR
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