Healthcare Provider Details

I. General information

NPI: 1578090908
Provider Name (Legal Business Name): CRYSTEN BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTEN BEARD

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 E JOYCE BLVD
FAYETTEVILLE AR
72703-4519
US

IV. Provider business mailing address

2474 E JOYCE BLVD STE 2
FAYETTEVILLE AR
72703-4932
US

V. Phone/Fax

Practice location:
  • Phone: 479-422-2915
  • Fax:
Mailing address:
  • Phone: 479-422-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: