Organization
UNIVERSITY OF ARKANSAS MEDICAL SCIENCES, AHEC PINE BLUFF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TIMOTHY KITTELL M.D. (PHYSICIAN)
(870) 541-6000
Entity
Organization
Contact information
Practice address
4747 DUSTY LAKE DR, STE 203, PINE BLUFF, AR 71603-8742
(870) 541-9300
Mailing address
12 SEZANNE CV, LITTLE ROCK, AR 72223-5093
(501) 821-7795
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
E5801
AR
261QP2300X
Primary Care Clinic/Center
E5801
AR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
440144201
—
AR
01
—
E-5801
ARKANSAS STATE MEDICAL BOARD
AR
Enumeration date
10/19/2006
Last updated
08/30/2010
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