Healthcare Provider Details

I. General information

NPI: 1962333047
Provider Name (Legal Business Name): NATALIE MARINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 KIBLER RD
VAN BUREN AR
72956-8406
US

IV. Provider business mailing address

4733 KIBLER RD
VAN BUREN AR
72956-8406
US

V. Phone/Fax

Practice location:
  • Phone: 479-268-2949
  • Fax:
Mailing address:
  • Phone: 479-268-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number203516
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: