PREMIER DERMATOLOGY & SKIN RENEWAL CENTER (NPI# 1912912361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912912361 |
| Entity Type | Organization |
| Organization Name | PREMIER DERMATOLOGY & SKIN RENEWAL CENTER |
| Practice Address |
909 Se 28th St Ste 5 Bentonville AR 72712-3880 |
| Practice Telephone | 4792733376 |
| Practice Fax Number | 4792733468 |
| Mailing Telephone | 4792733376 |
| Mailing Fax Number | 4792733468 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JEFF CLIFTON (COO) |
| Authorized Official Telephone | 4792733376 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207N00000X | Dermatology | E3363 | AR | Allopathic & Osteopathic Physicians |
| X | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
E3363 | AR | Allopathic & Osteopathic Physicians |
| X | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
E3363 | AR | Allopathic & Osteopathic Physicians |
| X | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | NPI - MILDRED CLIFTON, MD | 1679521405 | 01 |
| AR | QUALCHOICE | 03060015000 | 01 |
| Street Address |
909 SE 28TH ST STE 5 |
| City | BENTONVILLE |
| State | AR |
| Zip Code | 72712-3880 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811135809 | Advanced Aesthetics & Wellness Center Pa, Earlmd Family Medicine Pa | Family Medicine | 909 Se 28th St, Suite 9, Bentonville, AR 72712-3880 | 2009-01-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662345 | Bentonville Ambulatory Surgery Center, LLC | Pain Medicine | 2902 We Mid-cities Dr, Bentonville, AR 72712 | 2020-09-08 |
| 1942837059 | Amy Crumpton | Counselor | 3504 Se Riveria Road, Bentonville, AR 72712 | 2020-03-26 |
| 1295361509 | Unbridled Holdings LLC | Physical Therapy Assistant | 9900 Price Coffee Rd, Bentonville, AR 72712 | 2020-03-18 |
| 1649803552 | Hanna Kathryn Baxendale | Pediatrics | 2900 Medical Pkwy, Ste #370, Bentonville, AR 72712 | 2020-02-19 |
| 1740746635 | Meredith C Hodges | Counselor | 2508 Se 2oth St, Bentonville, AR 72712 | 2019-02-15 |
| 1609352566 | Tripharma Inc | Pharmacy | 3500 Sw Regional Airport Blvd Ste 2, Bentonville, AR 72712 | 2018-07-13 |
| 1811406747 | Upspring Therapy, LLC | Counselor | 2106 Sw Walton Blvd, Suite B, Bentonville, AR 72712 | 2017-09-22 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1508399502 | Rosanna Nicole Rephan | Nurse Practitioner | 3101 14th St, Mercy Convenient Care, Bentonville, AR 72712 | 2017-04-06 |
| 1417305517 | Charlotte Lennette Stephenson | Behavioral Analyst | 2005 S.e. Walton Blvd., Bentonville, AR 72712 | 2016-05-31 |
| Find all providers in zip 72712 | ||||
| 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 |
|---|---|---|---|---|
| 1679521405 | Mildred Murphy Clifton | Dermatology | 901 Se Plaza Ave, Ste 5, Bentonville, AR 72712-5697 | 2006-05-04 |
| 1134105042 | Eric Eugene Belin | Dermatology | 901 Se Plaza Ave Ste 5, Bentonville, AR 72712 | 2005-12-22 |
| 1326492869 | Cheri Caroline Cunningham | Dermatology | 901 Se Plaza Ave Ste 5, Bentonville, AR 72712-5473 | 2016-04-21 |
| 1386022283 | Premier Dermatology, Pllc | Dermatology | 901 Se Plaza Ave, Suite 5, Bentonville, AR 72712-5697 | 2015-05-12 |
| 1992119770 | Rebekah Grace Baltz | Dermatology | 901 Se Plaza Ave Ste 5, Bentonville, AR 72712-5473 | 2014-06-19 |
| 1194082057 | Blake Anthony Williams | Dermatology | 901 Se Plaza Ave, Suite 5, Bentonville, AR 72712-5697 | 2012-04-17 |
| 1033319686 | Kattie J Allen | Dermatology | 901 Se Plaza Ave, Suite 5, Bentonville, AR 72712-5697 | 2007-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677737 | Prime Medical Group Pllc | Dermatology | 1416 W 43rd Ave, Pine Bluff, AR 71603-7010 | 2020-10-20 |
| 1790384808 | Prime Medical Group Pllc | Dermatology | 625 United Dr Ste 320, Conway, AR 72032-7828 | 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 |
| Find all providers with the same taxonomy | ||||
| City | BENTONVILLE |
| Zip Code | 72712 |
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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.