| Autumn Road Family Practice, P.a, | |
|
904 Autumn Rd Suite 200 Little Rock AR 72211-3737 | |
| (501) 227-6363 | |
| (501) 227-8629 |
| Full Name | Autumn Road Family Practice, P.a, |
|---|---|
| Speciality | Clinic/Center |
| Location | 904 Autumn Rd, Little Rock, Arkansas |
| Authorized Official Name and Position | Dawn Drennan (ADMINISTRATOR) |
| Authorized Official Contact | 5016267515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Road Family Practice, P.a, 904 Autumn Rd Suite 200 Little Rock AR 72211-3737 Ph: (501) 227-6363 | Autumn Road Family Practice, P.a, 904 Autumn Rd Suite 200 Little Rock AR 72211-3737 Ph: (501) 227-6363 |
| NPI Number | 1629027818 |
|---|---|
| Provider Enumeration Date | 05/08/2006 |
| Last Update Date | 05/31/2022 |
| Medicare PECOS PAC ID | 1153458625 |
|---|---|
| Medicare Enrollment ID | O20100415000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629027818 | NPI | - | NPPES |
| 111026102 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MC0079 (Arkansas) | Primary |
| Provider Name | Daniel Wesley Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841260122 PECOS PAC ID: 0648307116 Enrollment ID: I20100415000629 |
| Provider Name | Joni E Barker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801177720 PECOS PAC ID: 1052583721 Enrollment ID: I20111003000266 |
| Provider Name | Daniel P Hardin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467613000 PECOS PAC ID: 0941474548 Enrollment ID: I20111116000804 |
| Provider Name | John P Pounders |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497046015 PECOS PAC ID: 0244458057 Enrollment ID: I20140820000220 |
| Provider Name | Sara B Blair |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1093072597 PECOS PAC ID: 1951627736 Enrollment ID: I20160715000205 |
| Provider Name | Atalie K Sessions |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043730328 PECOS PAC ID: 7810269784 Enrollment ID: I20170828002458 |
| Provider Name | Erin Hekmatpour |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285780809 PECOS PAC ID: 7719025139 Enrollment ID: I20190110000715 |
| Provider Name | Lauren Coker Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700498110 PECOS PAC ID: 0446677413 Enrollment ID: I20200908000173 |
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