Healthcare Provider Details

I. General information

NPI: 1457107831
Provider Name (Legal Business Name): KIMBERLY LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W MAIN ST
CABOT AR
72023-7463
US

IV. Provider business mailing address

3350 W MAIN ST
CABOT AR
72023-7463
US

V. Phone/Fax

Practice location:
  • Phone: 501-328-3274
  • Fax: 501-358-6264
Mailing address:
  • Phone: 501-328-3274
  • Fax: 501-358-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: