Provider Demographics
NPI:1962170597
Name:CARR, KAITLYN LOMAX
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LOMAX
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 GENE GEORGE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2227
Mailing Address - Country:US
Mailing Address - Phone:870-243-9390
Mailing Address - Fax:
Practice Address - Street 1:2575 GENE GEORGE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2227
Practice Address - Country:US
Practice Address - Phone:870-243-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician