Healthcare Provider Details

I. General information

NPI: 1972426955
Provider Name (Legal Business Name): REBECCA ANNE GOODRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 HILLCREST DR
JONESBORO AR
72401-5124
US

IV. Provider business mailing address

2717 GALLAWAY LN
JONESBORO AR
72404-7823
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-5830
  • Fax:
Mailing address:
  • Phone: 870-933-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL058581
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: