RUSSELL DERMATOLOGY OF CONWAY, PLLC (NPI# 1639134067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639134067 |
| Entity Type | Organization |
| Organization Name | RUSSELL DERMATOLOGY OF CONWAY, PLLC |
| Practice Address |
2425 Dave Ward Dr Suite 202 Conway AR 72034-8686 |
| Practice Telephone | 5013285050 |
| Practice Fax Number | 5013282131 |
| Mailing Telephone | 5013285050 |
| Mailing Fax Number | 5013282131 |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2010-10-28 |
| Authorized Official Name | MRS. JACKIE D RUSSELL (BUS/OFFICE MGR) |
| Authorized Official Telephone | 5013285050 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | E1574 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 140625002 | 05 |
| Street Address |
2425 DAVE WARD DR SUITE 202 |
| City | CONWAY |
| State | AR |
| Zip Code | 72034-8686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801884622 | Jeffrey P Kirsch | Specialist | 2425 Dave Ward Dr, Ste 101, Conway, AR 72034-8686 | 2005-10-06 |
| 1467089599 | Conway Ambulatory Surgery Center, LLC | Clinic/Center | 2425 Dave Ward Dr, Conway, AR 72034-8686 | 2020-03-26 |
| 1114461118 | Leah Marie Lamb | Pharmacist | 2425 Dave Ward Dr, Suite 602, Conway, AR 72034-8686 | 2016-12-09 |
| 1962862557 | Rachel Choate | Nurse Practitioner | 2425 Dave Ward Dr, Suite 202, Conway, AR 72034-8686 | 2016-02-25 |
| 1992180269 | Natalie Claire Brownd | Nurse Practitioner | 2425 Dave Ward Dr, Suite #401, Conway, AR 72034-8686 | 2015-07-28 |
| 1871990937 | The Pain Medicine Consultants Group | Durable Medical Equipment & Medical Supplies | 2425 Dave Ward Dr, Gordy Building Ste 102, Conway, AR 72034-8686 | 2014-12-04 |
| 1558667683 | Annette N. Anderson, Md, Pa | Psychiatry & Neurology | 2425 Dave Ward Dr, Suite 102, Conway, AR 72034-8686 | 2011-02-08 |
| 1851697197 | Jaclyn J Cooper | Nurse Practitioner | 2425 Dave Ward Dr, Suite 601, Conway, AR 72034-8686 | 2011-02-03 |
| 1902043227 | Saint-mark Enterprises 1890 LLC | Pharmacy | 2425 Dave Ward Dr, Suite 602, Conway, AR 72034-8686 | 2009-01-08 |
| 1558536219 | Kathleen E. Phillips | Audiologist | 2425 Dave Ward Dr, Suite 101, Conway, AR 72034-8686 | 2008-04-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013563758 | Shelby M Perez | Case Manager/Care Coordinator | 3240 Stermer Rd, Conway, AR 72034 | 2019-08-16 |
| 1467932772 | Faith J Parfait | Licensed Practical Nurse | 1352 Watkins St, Conway, AR 72034 | 2018-08-16 |
| 1043790611 | David Adam Steinfeld | Nurse Practitioner | 855 S German Ln Ste 1, Conway, AR 72034 | 2018-08-14 |
| 1245728484 | Conway Behavioral Health, LLC | Psychiatry & Neurology | 2255 Sturgis Rd, Conway, AR 72034 | 2018-04-24 |
| 1972007292 | Eldercare of Arkansas IIi, Inc. | Assisted Living Facility | 1306 S. Donaghey, Conway, AR 72034 | 2018-03-21 |
| 1528561404 | Kouhei Kobayashi | Specialist/Technologist | 2201 Moix Blvd., Apt. 908, Conway, AR 72034 | 2018-03-16 |
| 1780191015 | Sydnie Thessing | Nurse Practitioner | 605 Dave Ward Drive #105, Conway, AR 72034 | 2018-01-09 |
| 1508371865 | Ebony Latreace Charleston | Case Manager/Care Coordinator | 3240 Stermer Road, Conway, AR 72034 | 2017-12-08 |
| 1689190647 | Denise Annette Aikman | Dentist | 1210 Hogan Lane, Suite 200, Conway, AR 72034 | 2017-08-21 |
| 1134669138 | Hortons Orthotic Lab, Inc. | Prosthetic/Orthotic Supplier | 635 Dave Ward, Suite 103, Conway, AR 72034 | 2017-02-24 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790384808 | Prime Medical Group Pllc | Dermatology | 625 United Dr Ste 320, Conway, AR 72032-7828 | 2020-10-20 |
| 1588643563 | Thomas Floyd Hudson IIi | Dermatology | 9 Medical Lane, Conway, AR 72034 | 2006-01-10 |
| 1245411891 | Tom Hudson LLC | Dermatology | 9 Medical Lane, Conway, AR 72034 | 2007-11-23 |
| 1457330011 | Shelley W Russell | Dermatology | 2425 Dave Ward Dr, Suite 202, Conway, AR 72034-8686 | 2006-01-12 |
| 1033198510 | Eric Brian Russell | Dermatology | 2425 Dave Ward Dr, Suite 202, Conway, AR 72034-8686 | 2006-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677737 | Prime Medical Group Pllc | Dermatology | 1416 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2020-10-20 |
| 1649879750 | Prime Medical Group Pllc | Dermatology | 5 Medical Park Dr Ste 200, Benton, AR 72015-3732 | 2020-10-20 |
| 1528667672 | Prime Medical Group Pllc | Dermatology | 315 Section Line Rd Ste A&b, Hot Springs, AR 71913-6480 | 2020-10-20 |
| 1487064473 | Laura Raquel Battle | Dermatology | 500 South 52nd Street, Rogers, AR 72758-7275 | 2014-04-30 |
| 1174942528 | Jacey Tanner Guthrie | Dermatology | 4200 N Rodney Parham Rd Ste 202, Little Rock, AR 72212 | 2014-04-14 |
| 1801215751 | Allison Noel Hood | Dermatology | 9601 Baptist Health Drive Suite 860, Little Rock, AR 72205 | 2014-04-08 |
| 1710229141 | Mallory Hurst | Dermatology | 800 S Church St Ste 202, Jonesboro, AR 72401 | 2013-03-24 |
| 1720333990 | Vivian Shi | Dermatology | 4018 W Capitol Ave, Little Rock, AR 72205 | 2012-07-13 |
| 1295098440 | Garrett James Nelson | Dermatology | 9601 Baptist Health Dr Ste 690, Little Rock, AR 72205-6328 | 2012-06-22 |
| 1922398577 | Megan Suzanne Evans | Dermatology | 1 Childrens Way # 576, Little Rock, AR 72202-3500 | 2011-04-17 |
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| 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.