Healthcare Provider Details

I. General information

NPI: 1588592539
Provider Name (Legal Business Name): KRISTEN MIRANDA SCEGO INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S PINE ST
HARRISON AR
72601-5830
US

IV. Provider business mailing address

PO BOX 1131
HARRISON AR
72602-1131
US

V. Phone/Fax

Practice location:
  • Phone: 870-204-6016
  • Fax: 870-782-2914
Mailing address:
  • Phone: 870-204-6016
  • Fax: 870-782-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: