Healthcare Provider Details

I. General information

NPI: 1477482461
Provider Name (Legal Business Name): KAITLYN CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N EAST ST
BENTON AR
72015-3867
US

IV. Provider business mailing address

3321 S BOWMAN RD APT 632
LITTLE ROCK AR
72211-4676
US

V. Phone/Fax

Practice location:
  • Phone: 501-301-4350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5824
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: