Healthcare Provider Details

I. General information

NPI: 1215721535
Provider Name (Legal Business Name): TARA SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S MAIN ST
DECATUR AR
72722-9799
US

IV. Provider business mailing address

PO BOX 130
ROGERS AR
72757-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-212-5030
  • Fax: 479-212-5029
Mailing address:
  • Phone: 479-212-5030
  • Fax: 479-212-5029

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: