UNIVERSITY OF ARKANSAS MEDICAL SCIENCES, AHEC PINE BLUFF (NPI# 1881776987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881776987 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF ARKANSAS MEDICAL SCIENCES, AHEC PINE BLUFF |
| Practice Address |
4747 Dusty Lake Dr Ste 203 Pine Bluff AR 71603-8742 |
| Mailing Address |
12 Sezanne Cv Little Rock AR 72223-5093 |
| Practice Telephone | 8705419300 |
| Mailing Telephone | 5018217795 |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2010-08-30 |
| Authorized Official Name | DR. MICHAEL TIMOTHY KITTELL (PHYSICIAN) |
| Authorized Official Telephone | 8705416000 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QE0002X |
Clinic/Center Specialization: Emergency Care |
E5801 | AR | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
E5801 | AR | Ambulatory Health Care Facilities |
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 440144201 | 05 | |
| AR | ARKANSAS STATE MEDICAL BOARD | E-5801 | 01 |
| Street Address |
4747 DUSTY LAKE DR STE 203 |
| City | PINE BLUFF |
| State | AR |
| Zip Code | 71603-8742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518922632 | Paul W Davis Md Pa | Family Medicine | 4747 Dusty Lake Dr, Ste G1, Pine Bluff, AR 71603-9056 | 2006-04-20 |
| 1497102040 | Jefferson Hospital Association, Inc | Family Medicine | 4747 Dusty Lake Dr, Suite 202, Pine Bluff, AR 71603-8742 | 2016-05-24 |
| 1326354739 | Leslie Amber Adams | Nurse Practitioner | 4747 Dusty Lake Dr, Suite G1, Pine Bluff, AR 71603-8742 | 2010-08-23 |
| 1578892097 | Physician's Sleep Clinic Pllc | Clinic/Center | 4747 Dusty Lake Dr, Suite 204, Pine Bluff, AR 71603-8742 | 2009-12-11 |
| 1548457146 | Little Rock Vamc | Clinic/Center | 4747 Dusty Lake Dr, Pine Bluff, AR 71603-8742 | 2007-09-27 |
| 1861685570 | Roslyn Denise Burks | Nurse Practitioner | 4747 Dusty Lake Dr, Suite G-1, Pine Bluff, AR 71603-8742 | 2007-08-26 |
| 1780877969 | Kenneth Doyne Dill | Family Medicine | 4747 Dusty Lake Dr, Suite 202, Pine Bluff, AR 71603-8742 | 2007-08-22 |
| 1598961047 | Bryan D. Raymundo | Family Medicine | 4747 Dusty Lake Dr, Suite 203, Pine Bluff, AR 71603-9058 | 2007-06-22 |
| 1831130764 | Jefferson Hospital Association Inc | Family Medicine | 4747 Dusty Lake Dr, Suite 202, Pine Bluff, AR 71603-8742 | 2006-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700445038 | Hannah Carter | Dentist | 3801 S Olive St, Pine Bluff, AR 71603 | 2019-06-11 |
| 1821544628 | Nauman Yunus Md Pa | Internal Medicine | 1600 West 40th Ave, Jefferson Regional Medical Center, Pine Bluff, AR 71603 | 2016-08-31 |
| 1407278120 | Arkansas Cancer Clinic Pa | Radiology | 7200 South Hazel Street, Pine Bluff, AR 71603 | 2014-01-15 |
| 1730515396 | Sharon Yvette Webb | Student in an Organized Health Care Education/Training Program | 2318 Kyle Street, Pine Bluff, AR 71603 | 2013-09-16 |
| 1477992733 | David Larry Byrd | Pharmacist | 5 Longmeadow, Pine Bluff, AR 71603 | 2013-06-20 |
| 1437400371 | Thomas Jordan Harper | Pharmacist | 2809 South Camden Road, Pine Bluff, AR 71603 | 2012-10-01 |
| 1992080469 | C&d Disability.inc | Early Intervention Provider Agency | 4806 W 9th Street, Pine Bluff, AR 71603 | 2011-10-17 |
| 1457645863 | Clifton G Roaf & Marvin Q Caudle | Dentist | 1310 South Linden Street, Pine Bluff, AR 71603 | 2011-06-02 |
| 1932402682 | Mary Campbell | Licensed Practical Nurse | 2302 W. 28th, Suite A, Pine Bluff, AR 71603 | 2010-12-17 |
| 1245468925 | Evan N Newbolt | Ophthalmology | 3805 West 28th Ave, Pine Bluff, AR 71603 | 2009-07-01 |
| Find all providers in zip 71603 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730515396 | Sharon Yvette Webb | Student in an Organized Health Care Education/Training Program | 2318 Kyle Street, Pine Bluff, AR 71603 | 2013-09-16 |
| 1104446103 | Tracey Lockhart | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 100, Pine Bluff, AR 71603-6069 | 2020-04-20 |
| 1073133179 | Sree Chellappan | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 100, Pine Bluff, AR 71603-6069 | 2020-04-20 |
| 1578183653 | Rebecca Broadbent | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 100, Pine Bluff, AR 71603-6069 | 2020-04-20 |
| 1205456217 | Candace Wilson | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 100, Pine Bluff, AR 71603-6069 | 2020-04-20 |
| 1316567415 | Tessa Cucurullo Herren | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 100, Pine Bluff, AR 71603-6069 | 2020-04-20 |
| 1487217592 | Amilyn M Worlobah | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 100, Pine Bluff, AR 71603-6319 | 2019-04-16 |
| 1770043044 | Riham M Wahba | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 1, Pine Bluff, AR 71603-6319 | 2019-03-22 |
| 1528528809 | Sania Sayani | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 1, Pine Bluff, AR 71603-6319 | 2019-03-22 |
| 1194285478 | Anum Rasheed | Student in an Organized Health Care Education/Training Program | 1601 W 40th Ave Ste 1, Pine Bluff, AR 71603-6319 | 2019-03-22 |
| Find all providers in PINE BLUFF | ||||
| City | PINE BLUFF |
| Zip Code | 71603 |
Please comment or provide details below to improve the information on UNIVERSITY OF ARKANSAS MEDICAL SCIENCES, AHEC PINE BLUFF.
| 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.