# UNIVERSITY OF ARKANSAS MEDICAL SCIENCES, AHEC PINE BLUFF

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881776987
- **Authorized official:** DR. MICHAEL TIMOTHY KITTELL M.D. (PHYSICIAN)
- **Authorized official phone:** (870) 541-6000

## Contact information

- **Practice address:** 4747 DUSTY LAKE DR, STE 203, PINE BLUFF, AR 71603-8742
- **Practice address phone:** (870) 541-9300
- **Mailing address:** 12 SEZANNE CV, LITTLE ROCK, AR 72223-5093
- **Mailing address phone:** (501) 821-7795

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QE0002X | Emergency Care Clinic/Center | E5801 | AR | — |
| 261QP2300X | Primary Care Clinic/Center | E5801 | AR | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | NULL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | — | — | Yes |

## Other

- **Enumeration date:** 10/19/2006
- **Last updated:** 08/30/2010