Provider Demographics
NPI:1518104843
Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type:Organization
Organization Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Other - Org Name:PROGRAM FOR YOUNG ADULTS, WALKER FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH PARA PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:TERAVEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-908-1662
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:UAMS #783
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-614-2182
Mailing Address - Fax:501-526-7958
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:UAMS #783
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-614-2182
Practice Address - Fax:501-526-7958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health