Individual provider Active NPI

David Keith Wilson II, DO

  • Pediatrics Physician
  • Little Rock, AR
National Provider Identifier
1578191383
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E-17127 Issued in AR
Practice address
1 Childrens Way # 512-1
Little Rock, AR 72202-3500
Phone
(501) 364-1874
Fax
(501) 364-5148
NPI assigned
Mar 28, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-17127 AR Primary

Addresses

Primary practice location

1 Childrens Way # 512-1
Little Rock, AR 72202-3500

Mailing address

1 Childrens Way # 653
Little Rock, AR 72202-3500
Phone (501) 364-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241022004623 AR Practitioner - Pediatric Medicine 8820412943 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
E-17127ARMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Sep 20, 2024 Accepting new patients
Arkansas Childrens Hospital Pediatrics CurrentSince Sep 20, 2024 Accepting new patients
Arkansas Children'S Hospital CurrentSince Sep 20, 2024 Accepting new patients
Arkansas Childrens Professional Services Organization LLC Pediatrics CurrentSince Jul 1, 2025 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Sep 20, 2024 Accepting new patients
University of Arkansas for Medical Sciences Pediatrics Current Accepting new patients
Arkansas Childrens Hospital Past Accepting new patients

Locations

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

4301 W Markham St
#51219A
Little Rock, AR 72205
Phone (501) 364-1874

1 Childrens Way
#653
Little Rock, AR 72202
Phone (501) 614-2006

1 Childrens Way
#5121
Little Rock, AR 72202
Phone (501) 364-5262

1 Childrens Way
#51219A
Little Rock, AR 72202
Phone (501) 364-1874

1 Childrens Way
Ste 653
Little Rock, AR 72202

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1578191383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1100",
            "fax_number": "501-526-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 512-1",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1874",
            "fax_number": "501-364-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DAVID",
        "middle_name": "KEITH",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-28",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-17127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.