Healthcare Provider Details

I. General information

NPI: 1831768787
Provider Name (Legal Business Name): KRISTEN ANN MCCOMBS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 E MAIN ST
CHARLESTON AR
72933-9254
US

IV. Provider business mailing address

8418 PENNY LN
RATCLIFF AR
72951-8908
US

V. Phone/Fax

Practice location:
  • Phone: 479-275-9169
  • Fax: 479-662-4766
Mailing address:
  • Phone: 479-847-6002
  • Fax: 479-662-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4542
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: