Healthcare Provider Details

I. General information

NPI: 1417544362
Provider Name (Legal Business Name): KRISTIN SKEESICK SADDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

IV. Provider business mailing address

10371 LORENA DR
CEDARVILLE AR
72932-9492
US

V. Phone/Fax

Practice location:
  • Phone: 479-973-6000
  • Fax:
Mailing address:
  • Phone: 318-518-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2104010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: