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KIDSCORP OF FAYETTEVILLE INC NPI 1790124659


NPI Information

NPI: 1790124659
Provider Name: KIDSCORP OF FAYETTEVILLE, INC
Classification: Clinic/Center - 261QD1600X
Entity Type: Organization

Specialization: Developmental Disabilities

Address:
2210 MAIN DR
SPRINGDALE, AR
ZIP 72762
Phone: (479) 856-6397
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KIDSCORP OF FAYETTEVILLE, INC is a developmental disabilities clinic center in Springdale, AR. The provider is an entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). KIDSCORP OF FAYETTEVILLE, INC NPI is 1790124659. The provider is registered as an organization entity type.

The provider's business location address is:

2210 MAIN DR
SPRINGDALE, AR
ZIP 72762-802
Phone: (479) 856-6397
Fax: (479) 856-6412

The provider's authorized official is Shelia D. Wilkerson .
The authorized official title is Clinical Director and has the following contact phone number (479) 986-5150.

The enumeration date for this NPI number is 6/24/2013 and was last updated on 10/25/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QD1600XClinic/CenterDevelopmental Disabilities28786ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1198277724MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.