Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 120725 | AR |
NPI | 1295383974 |
---|---|
Provider Name | Summer Brackett |
First Address | Maumelle, AR 72113-7750 |
Second Address | Little Rock, AR 72202-3500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 27/08/2019 |