Provider Demographics
NPI:1720861487
Name:ADCOCK, KAYLEA
Entity Type:Individual
Prefix:
First Name:KAYLEA
Middle Name:
Last Name:ADCOCK
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 1:132 MEDICAL CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8609
Mailing Address - Country:US
Mailing Address - Phone:870-845-8904
Mailing Address - Fax:870-845-8284
Practice Address - Street 1:132 MEDICAL CIR STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8609
Practice Address - Country:US
Practice Address - Phone:870-845-8904
Practice Address - Fax:870-845-8284
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist