Healthcare Provider Details

I. General information

NPI: 1114506466
Provider Name (Legal Business Name): WETHINGTON MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 DOLLARWAY RD STE 103
WHITE HALL AR
71602-3082
US

IV. Provider business mailing address

24113 WHIPPORWILL LN
BAUXITE AR
72011-9555
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-8800
  • Fax: 870-247-8802
Mailing address:
  • Phone: 501-940-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTYN WETHINGTON
Title or Position: OWNER/MANAGER
Credential: AU.D., CCC-A
Phone: 501-940-5373