Female

Katie J. Carillon P.A.C.

Medical Physician Assistant in Maumelle, AR(View on Map)

Full Name

Katie Janette Carillon P.A.C.

NPI Number

1649538679

NPI Type

Individual Provider

Gender

Female

Enumeration Date

04/27/2012

Specialties

(Taxonomies)

Code

363AM0700X

Primary Taxonomy

Yes

Licenses

State

Arkansas

License Number

PA468

Contact
Information

Purpose

Mailing
Location

Address

11001 EXECUTIVE CENTER DR STE 200
1701 CLUB MANOR DR STE 2B

City

Little Rock
Maumelle

State

AR
AR

Postal Code

72211-4393
72113-7401

Country

US
US

Telephone Number

(501) 851-7402
(501) 843-4555

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/20/2024

Provider Address