Healthcare Provider Details

I. General information

NPI: 1750946604
Provider Name (Legal Business Name): KALYN WELCH-ANDREW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALYN WELCH

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 N FISHER ST
JONESBORO AR
72401-2152
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: