Healthcare Provider Details

I. General information

NPI: 1891253670
Provider Name (Legal Business Name): KAYLYN WYNN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 W KINGSHIGHWAY STE 6-8
PARAGOULD AR
72450-2604
US

IV. Provider business mailing address

PO BOX 11064
FAYETTEVILLE AR
72703-1001
US

V. Phone/Fax

Practice location:
  • Phone: 870-540-5014
  • Fax:
Mailing address:
  • Phone: 870-520-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11982-M
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11982-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: