Provider Demographics
NPI:1134345390
Name:AUDRA POGUE, P.A.
Entity type:Organization
Organization Name:AUDRA POGUE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:479-883-1464
Mailing Address - Street 1:PO BOX 23164
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-0164
Mailing Address - Country:US
Mailing Address - Phone:479-883-1464
Mailing Address - Fax:479-648-1189
Practice Address - Street 1:8217 HUNTINGTON WAY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9731
Practice Address - Country:US
Practice Address - Phone:479-883-1464
Practice Address - Fax:479-648-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1389610742Medicaid
AR127991721Medicaid