Provider Demographics
NPI:1457318065
Name:RICHARDSON, ALISON (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 CHENAL PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2016
Mailing Address - Country:US
Mailing Address - Phone:501-725-7919
Mailing Address - Fax:501-239-8540
Practice Address - Street 1:15400 CHENAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2016
Practice Address - Country:US
Practice Address - Phone:501-725-7919
Practice Address - Fax:501-239-8540
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111026102Medicaid
AR154804001Medicaid
AR5M969Medicare ID - Type Unspecified
AR111026102Medicaid
ARI10486Medicare UPIN