Individual
KANEISHA AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QBHP
Contact information
Practice address
1800 LINDAUER RD, FORREST CITY, AR 72335-2404
(870) 494-4659
Mailing address
PO BOX 388, WYNNE, AR 72396-0388
(870) 208-9333
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180362795
—
AR
Enumeration date
09/18/2019
Last updated
09/18/2019
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