Healthcare Provider Details

I. General information

NPI: 1528975489
Provider Name (Legal Business Name): MIKAYLA ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 GRANT ST
MALVERN AR
72104-4700
US

IV. Provider business mailing address

203 WEST 11TH STREET
YELLVILLE AR
72687
US

V. Phone/Fax

Practice location:
  • Phone: 501-615-7593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number125369
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: