Provider Demographics
NPI:1104258714
Name:CUNNINGHAM, KARON PATRICE (LADAC)
Entity type:Individual
Prefix:MISS
First Name:KARON
Middle Name:PATRICE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N UNIVERSITY AVE
Mailing Address - Street 2:200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6343
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-2023
Practice Address - Street 1:1100 N UNIVERSITY AVE
Practice Address - Street 2:200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6343
Practice Address - Country:US
Practice Address - Phone:870-347-2534
Practice Address - Fax:870-347-2023
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator