Healthcare Provider Details

I. General information

NPI: 1477488674
Provider Name (Legal Business Name): CAMILLE GUDDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 E MATTHEWS AVE
JONESBORO AR
72401-3050
US

IV. Provider business mailing address

906 E MATTHEWS AVE
JONESBORO AR
72401-3050
US

V. Phone/Fax

Practice location:
  • Phone: 870-919-0274
  • Fax:
Mailing address:
  • Phone: 870-919-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5838
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: