Healthcare Provider Details

I. General information

NPI: 1336699941
Provider Name (Legal Business Name): MICHELLE KATHLEEN AULD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ADCOCK RD SUITE D
HOT SPRINGS AR
71913-8184
US

IV. Provider business mailing address

1661 AIRPORT RD SUITE D
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 501-547-5691
  • Fax: 501-651-4296
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberA004894
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: