Healthcare Provider Details

I. General information

NPI: 1962272864
Provider Name (Legal Business Name): MAKAYLA WHITING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 LONGVIEW DR STE B
JONESBORO AR
72401-5902
US

IV. Provider business mailing address

2911 LONGVIEW DR STE B
JONESBORO AR
72401-5902
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0238
  • Fax: 870-336-0239
Mailing address:
  • Phone: 870-336-0238
  • Fax: 870-336-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number202519
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: