Healthcare Provider Details

I. General information

NPI: 1831860972
Provider Name (Legal Business Name): ANNA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 E HIGHLAND DR
JONESBORO AR
72401-6231
US

IV. Provider business mailing address

2808 VILLAGE MEADOW CV
JONESBORO AR
72405-3792
US

V. Phone/Fax

Practice location:
  • Phone: 870-600-1314
  • Fax:
Mailing address:
  • Phone: 573-281-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR4115
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: