MEDICARE: MR. KALEB ANDREW BIVENS LMSW

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	104100000X	Social Worker	26467-M	AR
2	104100000X	Social Worker	PLMSW	AR

General Provider Information

NPI Number	:	1952281016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KALEB ANDREW BIVENS LMSW

Provider Business Mailing Address
First Line	:	1055 SUNFLOWER DR STE 104
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3651
Country	:	US
Telephone Number	:	501-431-0075
Fax Number	:	888-977-2956

Provider Business Practice Location Address
First Line	:	1055 SUNFLOWER DR STE 104
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3651
Country	:	US
Telephone Number	:	501-431-0075
Fax Number	:	888-977-2956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	12/16/2025

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