Healthcare Provider Details

I. General information

NPI: 1801750617
Provider Name (Legal Business Name): MEGAN WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 SE B ST
BENTONVILLE AR
72712-7941
US

IV. Provider business mailing address

2307 SE B ST
BENTONVILLE AR
72712-7941
US

V. Phone/Fax

Practice location:
  • Phone: 479-802-4798
  • Fax:
Mailing address:
  • Phone: 479-802-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberB202314011
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: