Provider Demographics
NPI:1629710728
Name:PRECIOUS KREATION CRANIAL PROSTHESIS SPECIALIST
Entity Type:Organization
Organization Name:PRECIOUS KREATION CRANIAL PROSTHESIS SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROSTHESIS SPECIALIST/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-626-1135
Mailing Address - Street 1:5212 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-3950
Mailing Address - Country:US
Mailing Address - Phone:501-626-1135
Mailing Address - Fax:
Practice Address - Street 1:5212 NELSON DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-3950
Practice Address - Country:US
Practice Address - Phone:501-626-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier