Healthcare Provider Details

I. General information

NPI: 1871305904
Provider Name (Legal Business Name): ADRIANA MAE-LYN MINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 UNDERHILL RD
BEEBE AR
72012-9751
US

IV. Provider business mailing address

2508 E JOHNSON AVE APT D11
JONESBORO AR
72405-1951
US

V. Phone/Fax

Practice location:
  • Phone: 501-230-3100
  • Fax: 501-882-9825
Mailing address:
  • Phone: 573-625-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: