Provider Demographics
NPI:1356934723
Name:HALE-OSMENT, KAITLYN A
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:A
Last Name:HALE-OSMENT
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 1:3085 DAVE WARD DR APT 316
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9414
Mailing Address - Country:US
Mailing Address - Phone:501-313-3902
Mailing Address - Fax:501-313-3902
Practice Address - Street 1:1125 OAK ST STE 308
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4359
Practice Address - Country:US
Practice Address - Phone:501-313-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2305007101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional