MEDICARE: BENTLEE KATHERINE RUNDELL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A005867	AR

General Provider Information

NPI Number	:	1538649231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENTLEE KATHERINE RUNDELL APRN

Provider Business Mailing Address
First Line	:	3519 WATSON RD
Second Line	:
City	:	GREENWOOD
State	:	AR
Zip	:	72936-9198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 JENNY LIND RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-9142
Country	:	US
Telephone Number	:	479-322-1901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	04/30/2019

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