Provider Demographics
NPI:1669065306
Name:MODERN MEDICAL SOLUTIONS OF ARKANSAS LLC
Entity type:Organization
Organization Name:MODERN MEDICAL SOLUTIONS OF ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-280-0250
Mailing Address - Street 1:500 S UNIVERSITY AVE STE A23
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5346
Mailing Address - Country:US
Mailing Address - Phone:501-280-0250
Mailing Address - Fax:501-280-0260
Practice Address - Street 1:500 S UNIVERSITY AVE STE A23
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5346
Practice Address - Country:US
Practice Address - Phone:501-280-0250
Practice Address - Fax:501-280-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty