Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2833 | AR |
NPI | 1003872763 |
---|---|
Provider Name | Karen Hairston |
First Address | Fayetteville, AR 72703-4519 |
Second Address | Fayetteville, AR 72703-4519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 09/07/2007 |