Provider Demographics
NPI:1912430018
Name:ALLEGIANT WELLNESS AND TESTOSTERONE REPLACEMENT, INC.
Entity Type:Organization
Organization Name:ALLEGIANT WELLNESS AND TESTOSTERONE REPLACEMENT, INC.
Other - Org Name:ALLEGIANT WELLNESS AND TESTOSTERONE REPLACEMENT HOT SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, AG-ACNP, TNCC
Authorized Official - Phone:501-503-9955
Mailing Address - Street 1:11121 N RODNEY PARHAM RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4158
Mailing Address - Country:US
Mailing Address - Phone:501-503-9955
Mailing Address - Fax:
Practice Address - Street 1:11121 N RODNEY PARHAM RD STE 2A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4158
Practice Address - Country:US
Practice Address - Phone:501-503-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care