Provider Demographics
NPI:1225257017
Name:MISTY ZELK, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:MISTY ZELK, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-225-9990
Mailing Address - Street 1:11908 KANIS RD
Mailing Address - Street 2:SUITE G-8
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3733
Mailing Address - Country:US
Mailing Address - Phone:501-225-9990
Mailing Address - Fax:501-225-9998
Practice Address - Street 1:11908 KANIS RD
Practice Address - Street 2:SUITE G-8
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3733
Practice Address - Country:US
Practice Address - Phone:501-225-9990
Practice Address - Fax:501-225-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1505174400000X
ARA01721363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1962401463OtherZELK NPI
AR1962401463OtherINDIVIDUAL NPI NUMBER
AR1730109877OtherINDIVIDUAL NPI NUMBER
AR5L527Medicare PIN
AR5F810Medicare PIN
AR1730109877OtherINDIVIDUAL NPI NUMBER
ARH19740Medicare UPIN
AR5A413Medicare PIN