MEDICARE: FIRST STEP ARKANSAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center	28516	AR

General Provider Information

NPI Number	:	1710322094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP ARKANSAS, LLC

Provider Business Mailing Address
First Line	:	2911 LONGVIEW DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401
Country	:	US
Telephone Number	:	870-336-0238
Fax Number	:	870-336-0239

Provider Business Practice Location Address
First Line	:	6263 HIGHWAY 49 SOUTH
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450
Country	:	US
Telephone Number	:	870-240-0444
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KEVIN JAMES
Credential	:
Telephone Number	:	870-336-0238

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	06/10/2022

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