Healthcare Provider Details

I. General information

NPI: 1609796135
Provider Name (Legal Business Name): LAURA NEILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGH SCHOOL DR
MAGNOLIA AR
71753-2203
US

IV. Provider business mailing address

1400 HIGH SCHOOL DR
MAGNOLIA AR
71753-2203
US

V. Phone/Fax

Practice location:
  • Phone: 870-901-2595
  • Fax: 870-901-2508
Mailing address:
  • Phone: 870-901-2595
  • Fax: 870-901-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number30517
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: