Healthcare Provider Details

I. General information

NPI: 1033405709
Provider Name (Legal Business Name): KARA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 HARRISBURG RD
JONESBORO AR
72404-8729
US

IV. Provider business mailing address

1903 MOUNT VERNON DR
JONESBORO AR
72401-3655
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-4535
  • Fax: 870-935-0554
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number2482
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: