Individual
MRS. MIGNON CHIDESTER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.S., P.T.
Contact information
Practice address
3304 S M ST, FORT SMITH, AR 72903-2903
(479) 785-4677
Mailing address
9500 DARLINGTON WAY, FORT SMITH, AR 72908-9296
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1916
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5W915
BCBS
AR
Enumeration date
03/24/2006
Last updated
07/08/2007
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