Healthcare Provider Details

I. General information

NPI: 1316805823
Provider Name (Legal Business Name): SAMANTHA ROSE O'NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W CLIFF DR
FAIRFIELD BAY AR
72088-2725
US

IV. Provider business mailing address

516 W CLIFF DR
FAIRFIELD BAY AR
72088-2725
US

V. Phone/Fax

Practice location:
  • Phone: 501-294-8725
  • Fax:
Mailing address:
  • Phone: 501-294-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: