Healthcare Provider Details

I. General information

NPI: 1841454378
Provider Name (Legal Business Name): PAMELIA LYNN KUYPER BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 PINE ST
ARKADELPHIA AR
71923-4919
US

IV. Provider business mailing address

5537 BLEAUX AVE
SPRINGDALE AR
72762-0737
US

V. Phone/Fax

Practice location:
  • Phone: 870-230-8364
  • Fax: 870-230-8381
Mailing address:
  • Phone: 479-872-5580
  • Fax: 479-872-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR31743
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: