Provider Demographics
NPI:1104210830
Name:COLE, AUDRA (DO)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SE 28TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4641
Mailing Address - Country:US
Mailing Address - Phone:479-271-0005
Mailing Address - Fax:479-273-1427
Practice Address - Street 1:1200 SE 28TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4641
Practice Address - Country:US
Practice Address - Phone:479-271-0005
Practice Address - Fax:479-273-1427
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology