Healthcare Provider Details

I. General information

NPI: 1497675342
Provider Name (Legal Business Name): KAILYN STRAUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 ELLIOTT ST
PEA RIDGE AR
72751-5073
US

IV. Provider business mailing address

2804 ELLIOTT ST
PEA RIDGE AR
72751-5073
US

V. Phone/Fax

Practice location:
  • Phone: 479-925-8630
  • Fax: 479-925-8630
Mailing address:
  • Phone: 479-925-8630
  • Fax: 479-925-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: