Organization
MENA PEDIATRIC CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISSA M GRANT MD (PHYSICIAN/OWNER)
(479) 394-5439
Entity
Organization
Contact information
Practice address
900 HIGHWAY 71 N, MENA, AR 71953-4304
(479) 394-5439
Mailing address
900 HIGHWAY 71 N, MENA, AR 71953-4304
(479) 394-5439
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194837001
—
AR
Enumeration date
07/24/2018
Last updated
06/11/2021
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