Healthcare Provider Details

I. General information

NPI: 1477478105
Provider Name (Legal Business Name): SANDRA KAY DUGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 ROGERS AVE STE 40N
FORT SMITH AR
72903-2040
US

IV. Provider business mailing address

205 WARE RD
GREENWOOD AR
72936-4908
US

V. Phone/Fax

Practice location:
  • Phone: 479-651-8893
  • Fax:
Mailing address:
  • Phone: 479-651-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3841
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: