Healthcare Provider Details

I. General information

NPI: 1558028316
Provider Name (Legal Business Name): ABAGAIL WEST QBHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 SOUTHWEST DR
JONESBORO AR
72401-5829
US

IV. Provider business mailing address

1707 LINWOOD DR STE B
PARAGOULD AR
72450-5365
US

V. Phone/Fax

Practice location:
  • Phone: 870-604-4455
  • Fax: 870-934-0847
Mailing address:
  • Phone: 870-604-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: