Healthcare Provider Details

I. General information

NPI: 1982938205
Provider Name (Legal Business Name): KEIAH HUNT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E MATTHEWS AVE STE A
JONESBORO AR
72401-4346
US

IV. Provider business mailing address

5537 BLEAUX AVE
SPRINGDALE AR
72762-0737
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-0424
  • Fax: 534-248-4225
Mailing address:
  • Phone: 479-872-5580
  • Fax: 479-872-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number216129
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: