Healthcare Provider Details

I. General information

NPI: 1760161681
Provider Name (Legal Business Name): MAEGAN LEA HOLLAWAY PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 HIGHWAY 62 412
HIGHLAND AR
72542-9477
US

IV. Provider business mailing address

PO BOX 176
CHEROKEE VILLAGE AR
72525-0176
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-3337
  • Fax: 870-856-3334
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: