Provider Demographics
NPI:1659439925
Name:PSYCHIATRIC ASSOCIATES OF ARKANSAS PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF ARKANSAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SUNNI
Authorized Official - Middle Name:D
Authorized Official - Last Name:THROGMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-228-7400
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 1050
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6379
Mailing Address - Country:US
Mailing Address - Phone:501-228-7400
Mailing Address - Fax:501-978-5726
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 1050
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6379
Practice Address - Country:US
Practice Address - Phone:501-228-7400
Practice Address - Fax:501-537-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR103T00000X, 1041C0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133291002Medicaid
AR57031OtherBLUECROSS AND BLUESHIELD
AR133291002Medicaid