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NPI Code Detail

MEDICARE: KATIE CLARK WADLINGTON MD

MEDICARE: KATIE CLARK WADLINGTON MD
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
1207N00000XDermatology PhysicianE-15363AR

General Provider Information

NPI Number : 1417445180
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE CLARK WADLINGTON MD
Provider Business Mailing Address
First Line : 7108 FOREST CANYON DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-4078
Country : US
Telephone Number : 318-243-7458
Fax Number :
Provider Business Practice Location Address
First Line : 5921 RILEY PARK DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-6103
Country : US
Telephone Number : 479-649-3376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2018
Last Update Date : 12/06/2022

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Directions to “ KATIE CLARK WADLINGTON MD” Practice Location

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