Organization
CHILD & ADOLESCENT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERN ANN SHOTTS MD (PHYSICIAN)
(870) 239-5437
Entity
Organization
Contact information
Practice address
1204 W KINGSHIGHWAY, PARAGOULD, AR 72450-4143
(870) 239-5437
(870) 239-4211
Mailing address
1204 W KINGSHIGHWAY, PARAGOULD, AR 72450-4143
(870) 239-5437
(870) 239-4211
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5B870
BLUE CROSS
AR
Enumeration date
12/04/2006
Last updated
07/21/2022
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