Provider Demographics
NPI:1386659076
Name:DESLAURIERS, S KILLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:KILLEEN
Last Name:DESLAURIERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 HINSON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3404
Mailing Address - Country:US
Mailing Address - Phone:501-221-1050
Mailing Address - Fax:501-221-2967
Practice Address - Street 1:11825 HINSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3404
Practice Address - Country:US
Practice Address - Phone:501-221-1050
Practice Address - Fax:501-221-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51369OtherBC/BS
ARB-90122Medicare UPIN
AR51369OtherBC/BS