Provider Demographics
NPI:1336698828
Name:APP OF ARKANSAS ED PLLC
Entity Type:Organization
Organization Name:APP OF ARKANSAS ED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-928-6264
Mailing Address - Street 1:PO BOX 4458 DEPT 159
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4458
Mailing Address - Country:US
Mailing Address - Phone:870-338-5800
Mailing Address - Fax:904-559-4370
Practice Address - Street 1:1801 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8998
Practice Address - Country:US
Practice Address - Phone:870-338-5800
Practice Address - Fax:904-559-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty