Healthcare Provider Details

I. General information

NPI: 1497691141
Provider Name (Legal Business Name): TWYLA LICATINO
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: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S OAKHILL DR
ROGERS AR
72758-4855
US

IV. Provider business mailing address

911 S OAKHILL DR
ROGERS AR
72758-4855
US

V. Phone/Fax

Practice location:
  • Phone: 832-387-3746
  • Fax:
Mailing address:
  • Phone: 832-387-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number944858151
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: