Healthcare Provider Details

I. General information

NPI: 1780329201
Provider Name (Legal Business Name): KESLEY M WINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32425 N FUTRALL DR
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 479-713-0000
  • Fax: 479-713-8375
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-19590
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: