Healthcare Provider Details

I. General information

NPI: 1790578037
Provider Name (Legal Business Name): ALLIE KENDRICK AUSTIN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SUGAR CREEK CTR
BELLA VISTA AR
72714-3507
US

IV. Provider business mailing address

22 SUGAR CREEK CTR
BELLA VISTA AR
72714-3507
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-0110
  • Fax:
Mailing address:
  • Phone: 479-876-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number203114
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: