Organization
RUSSELL DERMATOLOGY OF CONWAY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE D RUSSELL (BUS/OFFICE MGR)
(501) 328-5050
Entity
Organization
Contact information
Practice address
2425 DAVE WARD DR, SUITE 202, CONWAY, AR 72034-8686
(501) 328-5050
(501) 328-2131
Mailing address
2425 DAVE WARD DR, SUITE 202, CONWAY, AR 72034-8686
(501) 328-5050
(501) 328-2131
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
E1574
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140625002
—
AZ
Enumeration date
04/19/2006
Last updated
10/09/2025
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