Provider Demographics
NPI:1417445180
Name:WADLINGTON, KATIE CLARK (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:CLARK
Last Name:WADLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7108 FOREST CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-4078
Mailing Address - Country:US
Mailing Address - Phone:318-243-7458
Mailing Address - Fax:
Practice Address - Street 1:5921 RILEY PARK DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6103
Practice Address - Country:US
Practice Address - Phone:479-649-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-15363207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology