Healthcare Provider Details

I. General information

NPI: 1053733881
Provider Name (Legal Business Name): AUNDREA SOUDERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-4500
  • Fax:
Mailing address:
  • Phone: 870-563-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR65310
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: