Organization
CENTER FOR PEDIATRIC NEUROSCIENCE, PLLC
Active
Organization
CENTER FOR PEDIATRIC NEUROSCIENCE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOB D CASPALL M.B.A. (BUSINESS MANAGER)
(901) 603-9936
Entity
Organization
Contact information
Practice address
2808 FOX MEADOW LN, JONESBORO, AR 72404-9346
(870) 932-4245
Mailing address
PO BOX 814, WALNUT RIDGE, AR 72476-0814
(901) 603-9936
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
11-16P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118484
—
MS
05
—
189059744
—
AR
05
—
3583920
—
TN
01
—
4302608
BLUE CROSS BLUE SHIELD
TN
Enumeration date
12/08/2010
Last updated
07/10/2012
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