Arkansas Dermatology PLLC
Organization Active NPI Dermatology Physician · Little Rock, AR
NPI 1013930320 · NPPES record last updated Jun 9, 2025
Key facts
- NPI
- 1013930320
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- ARKANSAS DERMATOLOGY PLLC
- Practice address
- 9601 Baptist Health Dr Ste 860
Little Rock, AR 72205-6375 - Phone
- (501) 975-7455
- Fax
- (501) 975-3631
- NPI assigned
- Jul 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Kemmerly Drake Thomas
- Title
- Billing Manager
- Phone
- (501) 515-8136
Practitioners 24
-
Matthew Dinehart, MD
-
Scott Michael Dinehart, M.D.
-
Tiffany Taggart Riley, DNP, FNP-BC, APRN
-
Gregory Floyd Bell, PA-C
-
Hannah E Breau, PA-C
-
Randall L Breau, M.D.
-
Douglas A. Clark, P.A.
-
Avery E Collins, PA-C
-
Caleb Brett Mason, PA-C
-
Katherine A McCrady, PA-C
-
Emilee Odom, PA-C
-
Matthew Reynolds, P.A.
-
Patrick Joseph Stickle, PA-C
-
Marshall William Witt, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D2008889 | Arkansas Dermatology | Compliance | May 31, 2027 |
| 04D2028520 | Arkansas Dermatology | Compliance | Jul 11, 2028 |
| 04D2028584 | Arkansas Dermatology | Compliance | Jul 11, 2028 |
| 04D2063769 | Arkansas Dermatology | Compliance | Aug 4, 2026 |
| 04D2178013 | Arkansas Dermatology | Compliance | Mar 7, 2027 |
| 04D2253164 | Arkansas Dermatology | Compliance | Feb 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041201000966 | AR | Part B Supplier - Clinic/Group Practice | 2466418470 |
Receives reassigned benefits from 21 practitioners Practice locations: North Little Rock, AR; Stuttgart, AR; Searcy, AR; Russellville, AR; Little Rock, AR; Cabot, AR; Conway, AR; Hot Springs, AR… |
National Provider Directory
Locations
15506 Highway 5
Ste A
Cabot, AR 72023
Phone (501) 941-3101
1075 Andrews Dr
Conway, AR 72032
Phone (501) 513-9700
2645 Highway 25B
Heber Springs, AR 72543
Phone (501) 362-3100
120 Twin Points Rd
Hot Springs, AR 71913
Phone (501) 547-8372
500 S University Ave
Ste 708
Little Rock, AR 72205
Phone (501) 221-2700
9601 Baptist Health Dr
Ste 860
Little Rock, AR 72205
Phone (501) 975-7455
4261 Stockton Dr
Ste LL100
North Little Rock, AR 72117
4261 Stockton Dr
Ste 200
North Little Rock, AR 72117
Phone (501) 791-7546
2524 Crestwood Rd
Ste 3
North Little Rock, AR 72116
Phone (501) 791-7546
106 S Inglewood Ave
Ste B
Russellville, AR 72801
Phone (479) 223-5000
2605 E Moore Ave
Searcy, AR 72143
Phone (501) 265-1500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
9601 Baptist Health Dr Ste 860
Little Rock, AR 72205-6375
Mailing address
4261 Stockton Drive Suite Ll100
North Little Rock, AR 72117
Phone (501) 975-7456
Other practice location 1
120 Twin Points Road
Hot Springs, AR 71913
Phone (501) 547-8372
Other practice location 2
4261 Stockton Dr Ste 200
North Little Rock, AR 72117-2962
Phone (501) 791-7546
Other practice location 3
1708 N Buerkle St
Stuttgart, AR 72160-2518
Phone (870) 659-8050
Other practice location 4
2605 E Moore Ave
Searcy, AR 72143
Phone (501) 268-1500
Other practice location 5
500 S University Ave Ste 708
Little Rock, AR 72205-5372
Phone (501) 221-2700
Other practice location 6
9601 Baptist Health Dr Ste 1070
Little Rock, AR 72205-6332
Phone (501) 907-7330
Other practice location 7
15506 Highway 5 Ste A
Cabot, AR 72023-7695
Phone (501) 941-3101
Other practice location 8
2645 Highway 25B
Heber Springs, AR 72543-6305
Phone (501) 362-3100
Other practice location 9
106 S Inglewood Ave Ste B
Russellville, AR 72801-3353
Phone (479) 223-5000
Other practice location 10
1075 Andrews Dr
Conway, AR 72032-4090
Phone (501) 513-9700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 155107002 | Medicaid | AR |
Other providers in Little Rock, AR
- Arkansas Department of Health Tuberculosis
- Arkansas Department of Human Services
- Arkansas Dept. of Health and Human Services
- Arkansas Dept. of Health and Human Services
- Arkansas Dermatology Clinic PA
- Arkansas Dermatopathology PLLC
- Arkansas Diagnostic Center
- Arkansas Diagnostic Center, PA
- Arkansas Digestive Diseases Clinic
- Arkansas Doulas LLC
All providers in Little Rock, AR · Dermatology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.