CENTER FOR PEDIATRIC NEUROSCIENCE, PLLC (NPI# 1174826499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174826499 |
| Entity Type | Organization |
| Organization Name | CENTER FOR PEDIATRIC NEUROSCIENCE, PLLC |
| Practice Address |
2808 Fox Meadow Ln Jonesboro AR 72404-9346 |
| Mailing Address |
Po Box 814 Walnut Ridge AR 72476-0814 |
| Practice Telephone | 8709324245 |
| Mailing Telephone | 9016039936 |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2012-07-10 |
| Authorized Official Name | MR. JOB D CASPALL (BUSINESS MANAGER) |
| Authorized Official Telephone | 9016039936 |
| Authorized Official Credential | M.B.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 11-16P | AR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00118484 | 05 | |
| AR | 189059744 | 05 | |
| TN | BLUE CROSS BLUE SHIELD | 4302608 | 01 |
| TN | 3583920 | 05 |
| Street Address |
2808 FOX MEADOW LN |
| City | JONESBORO |
| State | AR |
| Zip Code | 72404-9346 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699829838 | Twyla Jane Banks | Speech-Language Pathologist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2007-01-23 |
| 1780218552 | Andrewniquis Perkins | Behavioral Analyst | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2020-03-02 |
| 1457990590 | Taylor Rhiannon Fortenberry | Behavioral Analyst | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2020-01-06 |
| 1265996474 | Carla Graddy | Occupational Therapist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2019-01-22 |
| 1144717885 | Hannah King | Occupational Therapist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2018-04-18 |
| 1356880827 | Shainna Wallis | Speech-Language Pathologist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2017-02-16 |
| 1598211906 | Kelsie Clark | Physical Therapist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2016-08-27 |
| 1932539970 | Manette Keller | Physical Therapist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2013-11-12 |
| 1609122027 | Vanessa N Williams | Physical Therapist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2012-08-03 |
| 1851690085 | Bethany D Moss | Physical Therapist | 2808 Fox Meadow Ln, Jonesboro, AR 72404-9346 | 2011-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740745967 | Imove, LLC | Physical Therapist | 8700 S. Caraway Rd., Apt. L2, Jonesboro, AR 72404 | 2019-02-01 |
| 1245728914 | Karina Coats | Nurse Anesthetist, Certified Registered | 2409 Skyline Pt, Jonesboro, AR 72404 | 2018-04-27 |
| 1619325263 | Kathryn Meyers | Specialist/Technologist | 1614 Latourette Ln Apt 2, Jonesboro, AR 72404 | 2016-05-24 |
| 1922476571 | Tmj and Facial Pain Center,llc | Dentist | 2600 Browns Lane, Ste B, Jonesboro, AR 72404 | 2015-09-11 |
| 1265828156 | Hd Dental, Pa Dba Smile Dental | Dentist | 6009 Highway 1 South, Jonesboro, AR 72404 | 2015-04-08 |
| 1124445358 | Tanner Wilson Jarrett | Occupational Therapy Assistant | 3114 Fox Road Suite A, Jonesboro, AR 72404 | 2014-03-26 |
| 1154759793 | Kasey Boyd | Specialist/Technologist | 1717 Hwy 163, Jonesboro, AR 72404 | 2013-10-17 |
| 1578848610 | Maria Ivonne Norman | Physical Therapist | 8700 S. Caraway Rd. Apt. L2, (the Meadows), Jonesboro, AR 72404 | 2011-10-20 |
| 1003198839 | Rachel Hollimon Golden | Speech-Language Pathologist | 4410 Harrisburg Rd., Jonesboro, AR 72404 | 2011-09-19 |
| 1225358021 | Darrell R Gann | Physical Therapy Assistant | 6040 Beaver Creek, Jonesboro, AR 72404 | 2010-06-03 |
| Find all providers in zip 72404 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841507894 | Kristin J Addison-brown | Clinical Neuropsychologist | 304 Southwest Sq, Jonesboro, AR 72401-5984 | 2010-09-10 |
| 1235465733 | Julia Olivia Land | Clinical Neuropsychologist | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2009-10-19 |
| 1871743328 | Emily Jo Anderson Mackillop | Clinical Neuropsychologist | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Medical Center, Jonesboro, GA 30236 | 2008-09-21 |
| 1720004716 | Dan Johnson | Clinical Neuropsychologist | 1201 Fleming Ave, Jonesboro, AR 72401 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902579 | Kaitlyn Marie Gall | Clinical Neuropsychologist | 6020 Warden Rd Ste 210, Sherwood, AR 72120-6015 | 2020-11-02 |
| 1033510037 | Seth T Sorensen | Clinical Neuropsychologist | 1 Childrens Way # 512-21, Little Rock, AR 72202 | 2014-09-09 |
| 1912205725 | Consulting Psychology of Western Arkansas, Inc. | Clinical Neuropsychologist | 1100 S Waldron Rd, Fort Smith, AR 72903-2552 | 2011-03-02 |
| 1851619613 | Neuropsychology Associates, P.a. | Clinical Neuropsychologist | 620 Dutton Mountain Rd, Center Ridge, AR 72027-8469 | 2010-05-04 |
| 1225367725 | Elizabeth Speck-kern | Clinical Neuropsychologist | 3 Innwood Cr., Ste 111, Little Rock, AR 72211 | 2009-12-11 |
| 1477785822 | Andrews Neuropsychology Consulting, Pplc | Clinical Neuropsychologist | 1701 Centerview Dr Ste 123, Little Rock, AR 72211-4311 | 2009-08-19 |
| 1851501803 | Garrett Andrews | Clinical Neuropsychologist | 2400 Riverfront Dr, Apt. 1437, Little Rock, AR 72202-2208 | 2007-05-22 |
| 1538215660 | Ronald Eugene Mcinroe | Clinical Neuropsychologist | 217 North East, Fayetteville, AR 72701 | 2007-01-25 |
| 1033285150 | William Austin Cochran IIi | Clinical Neuropsychologist | 287 Valley Club Cir, Little Rock, AR 72212-2934 | 2006-11-28 |
| 1740392919 | Jennifer Lewis Gess | Clinical Neuropsychologist | 4301 W Markham St # 554, Little Rock, AR 72205-7101 | 2006-08-31 |
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Please comment or provide details below to improve the information on CENTER FOR PEDIATRIC NEUROSCIENCE, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.