Organization
KIDSCORP OF FAYETTEVILLE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELIA D. WILKERSON MS, PT (CLINICAL DIRECTOR)
(479) 986-5150
Entity
Organization
Contact information
Practice address
2210 MAIN DR, SPRINGDALE, AR 72762-6802
(479) 856-6397
(479) 856-6412
Mailing address
PO BOX 130, ROGERS, AR 72757-0130
(479) 856-6397
(479) 856-6412
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
28786
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198277724
—
AR
Enumeration date
06/24/2013
Last updated
10/25/2017
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