Healthcare Provider Details

I. General information

NPI: 1619887213
Provider Name (Legal Business Name): VICTORIA ESTALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 E WALNUT ST
PARIS AR
72855-4225
US

IV. Provider business mailing address

2711 E WALNUT ST
PARIS AR
72855-4225
US

V. Phone/Fax

Practice location:
  • Phone: 844-963-3242
  • Fax: 479-208-5898
Mailing address:
  • Phone: 844-963-3242
  • Fax: 479-208-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number214141
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: