Provider Demographics
NPI:1346753332
Name:PINNACLE ALLERGY CLINIC, PLLC
Entity Type:Organization
Organization Name:PINNACLE ALLERGY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:NICHOLSON
Authorized Official - Last Name:RUDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-557-6445
Mailing Address - Street 1:16101 CANTRELL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4578
Mailing Address - Country:US
Mailing Address - Phone:501-557-6445
Mailing Address - Fax:
Practice Address - Street 1:16101 CANTRELL RD STE 104
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4578
Practice Address - Country:US
Practice Address - Phone:501-425-0322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8430261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129401001Medicaid