| Center For Pediatric Neuroscience, Pllc | |
|
2808 Fox Meadow Ln Jonesboro AR 72404-9346 | |
| (870) 932-4245 | |
| Not Available |
| Full Name | Center For Pediatric Neuroscience, Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2808 Fox Meadow Ln, Jonesboro, Arkansas |
| Authorized Official Name and Position | Job D Caspall (BUSINESS MANAGER) |
| Authorized Official Contact | 9016039936 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Pediatric Neuroscience, Pllc Po Box 814 Walnut Ridge AR 72476-0814 Ph: (901) 603-9936 | Center For Pediatric Neuroscience, Pllc 2808 Fox Meadow Ln Jonesboro AR 72404-9346 Ph: (870) 932-4245 |
| NPI Number | 1174826499 |
|---|---|
| Provider Enumeration Date | 12/08/2010 |
| Last Update Date | 07/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174826499 | NPI | - | NPPES |
| 3583920 | Medicaid | TN | |
| 4302608 | Other | TN | BLUE CROSS BLUE SHIELD |
| 00118484 | Medicaid | MS | |
| 189059744 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 11-16P (Arkansas) | Primary |
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