Individual
MICHELLE R PELLERIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
6801 PHOENIX AVE STE 2, FORT SMITH, AR 72903-5299
(479) 384-5378
(479) 385-5379
Mailing address
PO BOX 775641, CHICAGO, IL 60677-5641
(314) 364-4200
(314) 364-6321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-575
ID
363AM0700X
Medical Physician Assistant
PA-575
ID
363AS0400X
Surgical Physician Assistant
PA-575
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807321700
—
ID
Enumeration date
08/02/2006
Last updated
07/12/2024
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