Healthcare Provider Details

I. General information

NPI: 1922923978
Provider Name (Legal Business Name): AUDREY STITES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 CENTRAL AVE STE M
HOT SPRINGS AR
71913-5907
US

IV. Provider business mailing address

PO BOX 10267
CONWAY AR
72034-0003
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6535
  • Fax: 501-358-6536
Mailing address:
  • Phone: 501-358-3565
  • Fax: 501-358-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: