Healthcare Provider Details

I. General information

NPI: 1568324739
Provider Name (Legal Business Name): SERA TRIADIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SPRING HOUSE RD
MALVERN AR
72104-7053
US

IV. Provider business mailing address

PO BOX 12
MALVERN AR
72104-0012
US

V. Phone/Fax

Practice location:
  • Phone: 479-310-5245
  • Fax:
Mailing address:
  • Phone: 479-310-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY O LAFLORA
Title or Position: OWNER/ NURSE PRACTITIONER
Credential: CNP
Phone: 479-310-5245