Healthcare Provider Details

I. General information

NPI: 1700202991
Provider Name (Legal Business Name): MRS. CINDY DAWN MAGNESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E CRANDALL AVE STE B
HARRISON AR
72601-3628
US

IV. Provider business mailing address

213 APPROACH DR
HARRISON AR
72601-6704
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8484
  • Fax: 870-741-4088
Mailing address:
  • Phone: 870-741-0902
  • Fax: 870-741-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1904047
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: