Healthcare Provider Details

I. General information

NPI: 1811891112
Provider Name (Legal Business Name): TAKAYELEOONA ROME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N OAK ST APT O303
SPRINGDALE AR
72764-9610
US

IV. Provider business mailing address

5325 N OAK ST APT 303
SPRINGDALE AR
72764-9615
US

V. Phone/Fax

Practice location:
  • Phone: 479-802-4798
  • Fax: 479-668-0589
Mailing address:
  • Phone: 479-668-0589
  • Fax: 479-668-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number110082948
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: