NPIMap

Organization Active NPI

Premier Dermatology & Skin Renewal Center

  • Clinical & Laboratory Dermatological Immunology Physician
  • Bentonville, AR
National Provider Identifier
1912912361
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical & Laboratory Dermatological Immunology PhysicianTaxonomy code 207NI0002X
Legal business name
PREMIER DERMATOLOGY & SKIN RENEWAL CENTER
Practice address
909 SE 28TH St
Ste 5
Bentonville, AR 72712-3880
Phone
(479) 273-3376
Fax
(479) 273-3468
NPI assigned
Jul 31, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Jeff Clifton
Title
Coo
Phone
(479) 273-3376

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X E3363 AR
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X AR Primary
Pediatric Dermatology Physician 207NP0225X E3363 AR
Procedural Dermatology Physician 207NS0135X E3363 AR

Addresses

Primary practice location

909 SE 28TH St
Ste 5
Bentonville, AR 72712-3880

Mailing address

909 SE 28TH St
Ste 5
Bentonville, AR 72712-3880
Phone (479) 273-3376

Other identifiers 2

IdentifierTypeStateIssuer
1679521405OtherARNPI - MILDRED CLIFTON, MD
03060015000OtherARQUALCHOICE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1912912361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 SE 28TH ST",
            "address_2": "STE 5",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123880",
            "telephone_number": "479-273-3376",
            "fax_number": "479-273-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 SE 28TH ST",
            "address_2": "STE 5",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123880",
            "telephone_number": "479-273-3376",
            "fax_number": "479-273-3468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DERMATOLOGY & SKIN RENEWAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CLIFTON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "479-273-3376",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "E3363",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "AR",
            "license": null,
            "primary": true
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "AR",
            "license": "E3363",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AR",
            "license": "E3363",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - MILDRED CLIFTON, MD",
            "identifier": "1679521405",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "03060015000",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.