Individual
AUDREY WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4171 N CROSSOVER RD, FAYETTEVILLE, AR 72703-4591
(479) 521-1427
(479) 521-6520
Mailing address
1409 GARLAND AVE, TEXARKANA, AR 71854-4356
(870) 216-2812
(870) 772-5056
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/14/2014
Last updated
05/14/2014
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