Healthcare Provider Details

I. General information

NPI: 1679309090
Provider Name (Legal Business Name): ANNA CLAIRE CARAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BRADLEY DR
MOUNTAIN HOME AR
72653-2733
US

IV. Provider business mailing address

68 LESLIE LN
MOUNTAIN HOME AR
72653-5467
US

V. Phone/Fax

Practice location:
  • Phone: 870-340-2636
  • Fax:
Mailing address:
  • Phone: 870-405-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: