KIDSCORP OF FAYETTEVILLE, INC (NPI# 1790124659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790124659 |
| Entity Type | Organization |
| Organization Name | KIDSCORP OF FAYETTEVILLE, INC |
| Practice Address |
2210 Main Dr Springdale AR 72762-6802 |
| Mailing Address |
Po Box 130 Rogers AR 72757-0130 |
| Practice Telephone | 4798566397 |
| Practice Fax Number | 4798566412 |
| Mailing Telephone | 4798566397 |
| Mailing Fax Number | 4798566412 |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2017-10-25 |
| Authorized Official Name | MRS. SHELIA D. WILKERSON (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 4799865150 |
| Authorized Official Credential | MS, PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
28786 | AR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 198277724 | 05 |
| Street Address |
2210 MAIN DR |
| City | SPRINGDALE |
| State | AR |
| Zip Code | 72762-6802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679119275 | Destiny Savanna Harvey | Licensed Practical Nurse | 2210 Main Dr, Springdale, AR 72762-6802 | 2019-11-19 |
| 1417518135 | Ashley Marie Gray | Speech-Language Pathologist | 2210 Main Dr, Springdale, AR 72762-6802 | 2019-06-24 |
| 1376991190 | Leah Schumacher | Speech-Language Pathologist | 2210 Main Dr, Springdale, AR 72762-6802 | 2016-06-02 |
| 1588040711 | Coty Deutschman | Licensed Practical Nurse | 2210 Main Dr, Springdale, AR 72762-6802 | 2015-08-11 |
| 1902299498 | Ashlee Dupriest | Specialist/Technologist | 2210 Main Dr, Springdale, AR 72762-6802 | 2015-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861013443 | Samantha G Abbey | Behavior Technician | 6836 Issac's Orchard Rd, Springdale, AR 72762 | 2020-05-05 |
| 1598393605 | Highlands Oncology Group Pa | Pharmacy | 3901 Parkway Circle, Springdale, AR 72762 | 2020-04-01 |
| 1366922320 | Mercy Northwest Arkansas Ambulatory Services LLC | Clinic/Center | 4962 Elm Springs Road, Suite 5, Springdale, AR 72762 | 2018-08-20 |
| 1790281087 | Cheryl Nikol Treat | Nurse Practitioner | 6801 Isaacs Orchard Rd Ste 211, Springdale, AR 72762 | 2018-04-04 |
| 1902304876 | Northwest Arkansas Physical Ability Testing Center, P.a. | Clinic/Center | 4001 Wagon Wheel Road, Springdale, AR 72762 | 2018-01-25 |
| 1609387612 | Rodriguez Dentistry Pllc | Dentist | 1521 Executive Place, Suite A, Springdale, AR 72762 | 2017-10-17 |
| 1306370630 | Medworks LLC | Internal Medicine | 986 Elmwood, Suite C, Springdale, AR 72762 | 2017-04-13 |
| 1790223006 | Sam's West, Inc. | Technician/Technologist | 1517 Gene George Blvd, Springdale, AR 72762 | 2017-02-07 |
| 1255875746 | Arkansas Childrens Northwest, Inc. | General Acute Care Hospital | 2601 South 56th Street, Springdale, AR 72762 | 2016-12-19 |
| 1114473261 | Whitney E Mix | Counselor | 1672 South 48th Street, Suite B, Springdale, AR 72762 | 2016-08-29 |
| Find all providers in zip 72762 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962029694 | Developmental Milestones Adult Day Center | Clinic/Center | 700 N Missouri St, West Memphis, AR 72301-3150 | 2020-06-29 |
| 1891334835 | Abilities Pediatric Pllc | Clinic/Center | 908 Shorecrest Ave, Harrison, AR 72601-1953 | 2019-12-21 |
| 1912494527 | Equestrian Zone | Clinic/Center | 4800 S Frankfort Ave, Russellville, AR 72802-0823 | 2018-04-18 |
| 1174024715 | Lacretia Bruce | Clinic/Center | 12 Fox Run Dr, Little Rock, AR 72210-7133 | 2018-02-27 |
| 1215348552 | Tera Goodman | Clinic/Center | 15 Barber Dr, Hardy, AR 72542-9109 | 2014-05-08 |
| 1710322094 | First Step Arkansas, LLC | Clinic/Center | 6263 Highway 49 South, Paragould, AR 72450 | 2013-05-01 |
| 1043536063 | Cb King Uam Campus | Clinic/Center | 1711 East Ash Street, Mcgehee, AR 71654 | 2010-04-15 |
| 1508037870 | Kids for The Future Rogers, Inc. | Clinic/Center | 3307 N Dixieland Rd, Rogers, AR 72756-6816 | 2008-03-14 |
| 1306979265 | From The Beginning Chms Clinic | Clinic/Center | 120 Nix Ridge Rd, Ash Flat, AR 72513-9017 | 2007-03-13 |
| 1851458301 | Boone County Independent Living, Inc. | Clinic/Center | 206 S Cherry St Ste D, Harrison, AR 72601-5044 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGDALE |
| Zip Code | 72762 |
Please comment or provide details below to improve the information on KIDSCORP OF FAYETTEVILLE, INC.
| 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.