Organization
PEDIATRIC NUTRITION PROVIDER OF ARKANSAS
Active
Other names
Arkansas Respiratory & Equipment Provider
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE C MOTTO (CO-OWNER)
(501) 315-7337
Entity
Organization
Contact information
Practice address
920 EDISON AVE, SUITE 8, BENTON, AR 72015-4502
(501) 315-7337
Mailing address
920 EDISON AVE, SUITE 8, BENTON, AR 72015-4502
(501) 315-7337
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MG00511
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49908
BCBS
AR
Enumeration date
02/27/2007
Last updated
08/22/2020
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