| Katherine C Shook, Inc. | |
|
307 Sw 18th St Ste 3 Bentonville AR 72712-8478 | |
| (479) 721-1788 | |
| Not Available |
| Full Name | Katherine C Shook, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 307 Sw 18th St Ste 3, Bentonville, Arkansas |
| Authorized Official Name and Position | Katherine C Shook (PRESIDENT) |
| Authorized Official Contact | 4797211788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Katherine C Shook, Inc. Po Box 414 Garfield AR 72732-0414 Ph: (479) 721-1788 | Katherine C Shook, Inc. 307 Sw 18th St Ste 3 Bentonville AR 72712-8478 Ph: (479) 721-1788 |
| NPI Number | 1003680687 |
|---|---|
| Provider Enumeration Date | 11/14/2023 |
| Last Update Date | 12/08/2023 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 0143677245 |
|---|---|
| Medicare Enrollment ID | O20231110002855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003680687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Katherine Shook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003220906 PECOS PAC ID: 0941553010 Enrollment ID: I20190124001478 |
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