Healthcare Provider Details

I. General information

NPI: 1245738004
Provider Name (Legal Business Name): KAYLA MICHELLE DOLLAR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HIGHWAY 62 W
SALEM AR
72576-8059
US

IV. Provider business mailing address

49 HIGHWAY 62 412
ASH FLAT AR
72513-9594
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2015
  • Fax: 870-895-2015
Mailing address:
  • Phone: 573-718-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005459
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: