Clint E Bearden
Individual provider Active NPI Physician Assistant · Little Rock, AR
NPI 1851753776 · NPPES record last updated Mar 22, 2016
Key facts
- NPI
- 1851753776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PT2016-019 (AR)
- Practice address
- 10101 Mabelvale Plaza Dr
Suite 3
Little Rock, AR 72209-5927 - Phone
- (501) 568-7868
- NPI assigned
- Mar 22, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160427001129 | AR | Practitioner - Physician Assistant | 5698074573 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT2016-019 | AR | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PT2016-019 | AR | Yes |
Addresses
Primary practice location
10101 Mabelvale Plaza Dr
Suite 3
Little Rock, AR 72209-5927
Mailing address
10101 Mabelvale Plaza Dr
Suite 3
Little Rock, AR 72209-5927
Phone (501) 568-7868
Other providers in Little Rock, AR
- Shannon Beaney
- Brooke Nicole Bear
- Monica Lynn Beard-Raymond
- Jordan Beard
- Lasandra Nicole Beard
- Kendra Yvonne Bearden
- Phyllis A Bearden
- Shawnna Michelle Bearden
- Allison Beasley
- Antoinette Beasley
All providers in Little Rock, AR · Physician Assistant in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2016. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.