Healthcare Provider Details

I. General information

NPI: 1184415200
Provider Name (Legal Business Name): CALLIE OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: