Provider Demographics
NPI:1033766316
Name:AYERS, KAYDRA
Entity Type:Individual
Prefix:MS
First Name:KAYDRA
Middle Name:
Last Name:AYERS
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 1:777 HIGHWAY 84 E
Mailing Address - Street 2:
Mailing Address - City:UMPIRE
Mailing Address - State:AR
Mailing Address - Zip Code:71971-9026
Mailing Address - Country:US
Mailing Address - Phone:870-583-6738
Mailing Address - Fax:
Practice Address - Street 1:508 N. 2ND STREET
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852
Practice Address - Country:US
Practice Address - Phone:870-455-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator