| Arkansas Longevity Center, Pllc | |
|
2300 Andover Ct Ste 400 Little Rock AR 72227-3990 | |
| (501) 904-5157 | |
| Not Available |
| Full Name | Arkansas Longevity Center, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 2300 Andover Ct Ste 400, Little Rock, Arkansas |
| Authorized Official Name and Position | Oumitana Kajkenova (MEMBER) |
| Authorized Official Contact | 5019045157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arkansas Longevity Center, Pllc 1509 Dulles Dr Lafayette LA 70506-3718 Ph: () - | Arkansas Longevity Center, Pllc 2300 Andover Ct Ste 400 Little Rock AR 72227-3990 Ph: (501) 904-5157 |
| NPI Number | 1811426380 |
|---|---|
| Provider Enumeration Date | 06/08/2017 |
| Last Update Date | 12/17/2021 |
| Medicare PECOS PAC ID | 4183993082 |
|---|---|
| Medicare Enrollment ID | O20170710001047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811426380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Oumitana Kajkenova |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1053401521 PECOS PAC ID: 4880679109 Enrollment ID: I20040622000006 |
| Provider Name | Arpana Edala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265662969 PECOS PAC ID: 0941324487 Enrollment ID: I20100903000918 |
| Provider Name | Samantha Watt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851813141 PECOS PAC ID: 1052683836 Enrollment ID: I20170815001987 |
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