Healthcare Provider Details

I. General information

NPI: 1467260711
Provider Name (Legal Business Name): JUSTINA WARMOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 KEENER LN
HARRISON AR
72601-7522
US

IV. Provider business mailing address

4583 POWDER KEG LN
HARRISON AR
72601-7098
US

V. Phone/Fax

Practice location:
  • Phone: 870-302-9277
  • Fax:
Mailing address:
  • Phone: 870-577-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number202940
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: