Organization
SKIN DERMATOLOGY PRACTITIONER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY PEMBERTON NP (AUTHORIZED OFFICIAL)
(708) 530-2453
Entity
Organization
Contact information
Practice address
3106 SOUTHWEST DR STE 103, JONESBORO, AR 72404-8404
(870) 641-7546
(870) 641-7547
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(800) 824-4094
(479) 968-1673
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
06/21/2023
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