Healthcare Provider Details

I. General information

NPI: 1497688121
Provider Name (Legal Business Name): LAUREN WILBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BRADLEY DR
MOUNTAIN HOME AR
72653-2733
US

IV. Provider business mailing address

711 BRADLEY DR
MOUNTAIN HOME AR
72653-2733
US

V. Phone/Fax

Practice location:
  • Phone: 870-410-4144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12214-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: