Healthcare Provider Details

I. General information

NPI: 1205365046
Provider Name (Legal Business Name): AUDRA BOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDRA PIERCE

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 FOX MEADOW LN
JONESBORO AR
72404-9344
US

IV. Provider business mailing address

1600 ALDERSGATE RD STE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-4999
  • Fax:
Mailing address:
  • Phone: 870-910-4999
  • Fax: 870-910-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8371-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: