Healthcare Provider Details

I. General information

NPI: 1952281016
Provider Name (Legal Business Name): KALEB ANDREW BIVENS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SUNFLOWER DR STE 104
CONWAY AR
72034-3651
US

IV. Provider business mailing address

1055 SUNFLOWER DR STE 104
CONWAY AR
72034-3651
US

V. Phone/Fax

Practice location:
  • Phone: 501-431-0075
  • Fax: 888-977-2956
Mailing address:
  • Phone: 501-431-0075
  • Fax: 888-977-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26467-M
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: