Provider Demographics
NPI:1992758387
Name:PILLOW, CHARLES EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:PILLOW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-1028
Mailing Address - Country:US
Mailing Address - Phone:501-882-5433
Mailing Address - Fax:501-882-2512
Practice Address - Street 1:710-A DEWITT HENRY DRIVE
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012
Practice Address - Country:US
Practice Address - Phone:501-882-5433
Practice Address - Fax:501-882-2512
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA155363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMP0778780OtherDEA
ARMP0778780OtherDEA