Healthcare Provider Details

I. General information

NPI: 1598592370
Provider Name (Legal Business Name): Z'KIAH KUYKENDALL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 04/07/2025
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E. MEDICAL DRIVE
MANILA AR
72442
US

IV. Provider business mailing address

P.O. BOX 717
MANILA AR
72442
US

V. Phone/Fax

Practice location:
  • Phone: 870-570-0358
  • Fax: 870-570-0359
Mailing address:
  • Phone: 870-570-0358
  • Fax: 870-570-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA2503006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: