Healthcare Provider Details

I. General information

NPI: 1790621423
Provider Name (Legal Business Name): KAILA J MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 S 51ST ST
ROGERS AR
72758-8628
US

IV. Provider business mailing address

6504 S 51ST ST
ROGERS AR
72758-8628
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-6213
  • Fax:
Mailing address:
  • Phone: 870-365-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2338
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: