Individual
SUSAN M AVERITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5501 WILLOW CREEK DR. STE 203, SPRINGDALE, AR 72762
(479) 575-9359
(479) 575-9415
Mailing address
5501 WILLOW CREEK DR. STE 203, SPRINGDALE, AR 72762
(479) 757-8099
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
23620
OK
208000000X
Pediatrics Physician
Primary
E2459
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1324230001
PALMETTO DME
OK
05
—
1356304091
—
MO
05
—
140067001
—
AR
01
—
200016780A
SOONER PCP
OK
05
—
200016780A
—
OK
01
—
731310891028
TRICARE SOUTH
OK
01
—
74502A050
CHAMPUS (WPS)
OK
01
—
H14901
STERLING OPTION 1
OK
Enumeration date
04/11/2006
Last updated
07/21/2022
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