Provider Demographics
NPI:1649293754
Name:HESTER, SAMUEL BROUD (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BROUD
Last Name:HESTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5829
Mailing Address - Country:US
Mailing Address - Phone:870-932-1707
Mailing Address - Fax:870-932-1707
Practice Address - Street 1:260 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5829
Practice Address - Country:US
Practice Address - Phone:870-932-1707
Practice Address - Fax:870-932-1707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR81-4P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56233OtherBC/BS #
AR81-4POtherSTATE LICENSE #
AR56233Medicare ID - Type UnspecifiedMEDICARE #