Healthcare Provider Details

I. General information

NPI: 1629320817
Provider Name (Legal Business Name): KARLY WILLIAMS MHPP/CLF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 N ROBINSON ST
HARRISON AR
72601-3729
US

IV. Provider business mailing address

607 N ROBINSON ST
HARRISON AR
72601-3729
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-1610
  • Fax:
Mailing address:
  • Phone: 870-414-1610
  • Fax: 870-741-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: