Provider Demographics
NPI:1215736343
Name:MACK, JULIANNA (PA)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:MACK
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3063 RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5072
Mailing Address - Country:US
Mailing Address - Phone:501-517-1970
Mailing Address - Fax:
Practice Address - Street 1:300 S SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5725
Practice Address - Country:US
Practice Address - Phone:501-918-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant