MEDICARE: HEATHER DUKAT-GENTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1306255807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DUKAT-GENTRY

Provider Business Mailing Address
First Line	:	2700 N POPLAR ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2332
Country	:	US
Telephone Number	:	501-771-8000
Fax Number	:	501-771-8035

Provider Business Practice Location Address
First Line	:	2700 N POPLAR ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2332
Country	:	US
Telephone Number	:	501-771-8000
Fax Number	:	501-771-8035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	10/10/2019

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Directions to “ HEATHER DUKAT-GENTRY ” Practice Location

Language	Start Address	Practice Location

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