Individual
KIM CALLICUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 BLOCK ST, MARION, AR 72364-1956
(870) 636-9593
Mailing address
125 ALLEN CV, MARION, AR 72364-8001
(870) 636-9593
(870) 559-2803
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
225320732
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225320732
—
AR
Enumeration date
03/26/2019
Last updated
03/26/2019
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