Healthcare Provider Details

I. General information

NPI: 1154928356
Provider Name (Legal Business Name): KARLA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DIXIE ST
SOUTHSIDE AR
72501-7861
US

IV. Provider business mailing address

50 DIXIE ST
SOUTHSIDE AR
72501-7861
US

V. Phone/Fax

Practice location:
  • Phone: 870-291-0107
  • Fax:
Mailing address:
  • Phone: 870-291-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10289-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: