Healthcare Provider Details

I. General information

NPI: 1619784816
Provider Name (Legal Business Name): MALINDI HOLDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 W SOUTHERN HILLS BLVD STE 300
ROGERS AR
72758-8265
US

IV. Provider business mailing address

PO BOX 2109
RUSSELLVILLE AR
72811-2109
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-2322
  • Fax: 479-339-8760
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-339-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: