Healthcare Provider Details

I. General information

NPI: 1780548016
Provider Name (Legal Business Name): CASEY LAUGHLIN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N EDMONDS AVE
MC CRORY AR
72101-8000
US

IV. Provider business mailing address

1001 RICH DR
AUGUSTA AR
72006-9523
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-0345
  • Fax:
Mailing address:
  • Phone: 870-731-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: