Provider Demographics
NPI:1881887255
Name:PARAGOULD PEDIATRICS, PLLC
Entity type:Organization
Organization Name:PARAGOULD PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-236-7337
Mailing Address - Street 1:4000 LINWOOD DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7223
Mailing Address - Country:US
Mailing Address - Phone:870-236-7337
Mailing Address - Fax:870-236-7332
Practice Address - Street 1:4000 LINWOOD DR
Practice Address - Street 2:SUITE H
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7223
Practice Address - Country:US
Practice Address - Phone:870-236-7337
Practice Address - Fax:870-236-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165537002Medicaid
5F839OtherBLUE CROSS