SKIN DERMATOLOGY PRACTITIONER, PLLC
NPI 1003505389
Nurse Practitioner in Jonesboro, AR

Active since May 03, 2023CLIA 04D2283750 · Microscopy
3106 SOUTHWEST DR STE 103, JONESBORO, AR 72404(870) 641-7546(870) 641-7547 Get Directions Write a Review

NPPES record last updated: June 21, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 21, 2023, May 24, 2023, May 3, 2023 (3 updates tracked since 2023).

About Skin Dermatology Practitioner, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SKIN DERMATOLOGY PRACTITIONER, PLLC (NPI 1003505389) is a healthcare organization registered as a nurse practitioner in Jonesboro, Arkansas and active in the NPI registry since May 2023. The organization holds a CLIA Microscopy certificate valid through June 12, 2027 and lists Nancy Pemberton, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1003505389
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameSKIN DERMATOLOGY PRACTITIONER, PLLC
Location Address3106 SOUTHWEST DR STE 103Jonesboro, AR 72404-8404
Mailing AddressPo Box 9178Russellville, AR 72811-9178 · (800) 824-4094 · Fax (479) 968-1673
Fax(870) 641-7547
Organization SubpartNo
Authorized OfficialNancy PembertonAuthorized Official · (708) 530-2453
Enumeration DateMay 3, 2023
Last NPPES UpdateJune 21, 20233 updates tracked since enumeration
NPPES CertifiedJune 21, 2023
NPI 1003505389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

3106 SOUTHWEST DR STE 103, Jonesboro, AR 72404

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 04D2283750

Skin Dermatology Practitioner, PLLC · Jonesboro, AR
Active · expires Jun 12, 2027
CLIA Number04D2283750
Laboratory TypePhysician Office
Certificate Effective DateJune 13, 2025
Certificate Expiration DateJune 12, 2027
Laboratory DirectorNancy Pemberton
Laboratory Phone(870) 641-7546
Laboratory LocationSkin Dermatology Practitioner, PLLC3106 Southwest Drive, Suite 103, Jonesboro, AR 72404
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
3106 SOUTHWEST DR STE 103
JONESBORO, AR 72404

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003505389, enumerated as an "organization" on May 03, 2023.

The provider is located at 3106 SOUTHWEST DR STE 103 JONESBORO, AR 72404 and the phone number is (870) 641-7546.

Nurse Practitioner with taxonomy code 363L00000X.

The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to verify.