Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 121991 | AR |
NPI | 1780224923 |
---|---|
Provider Name | Tabitha Renae Mealer |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202-3500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2020 |
Last Update Date | 15/01/2020 |