Provider Demographics
NPI:1851753776
Name:BEARDEN, CLINT E
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:E
Last Name:BEARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 MABELVALE PLAZA DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-5927
Mailing Address - Country:US
Mailing Address - Phone:501-568-7868
Mailing Address - Fax:
Practice Address - Street 1:10101 MABELVALE PLAZA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-5927
Practice Address - Country:US
Practice Address - Phone:501-568-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2016-019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant