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General NPI Number Information
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NPI Number | 1811755218
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Entity Type | Organization
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Legal Business Name | PULASKI HEIGHTS WELLNESS CLINIC, PLLC
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 811 N GRANT ST APT 5B
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3262
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Country | US
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Telephone | 501-301-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 811 N GRANT ST APT 5B
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3262
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Country | US
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Telephone | 501-301-4554
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | JENNIFER SHULER
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Credential | APRN
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Telephone | 501-301-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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