Healthcare Provider Details

I. General information

NPI: 1679501027
Provider Name (Legal Business Name): KIMBERLY J. CARNEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SE 13TH CT
BENTONVILLE AR
72712-7857
US

IV. Provider business mailing address

1000 SE 13TH CT
BENTONVILLE AR
72712-7857
US

V. Phone/Fax

Practice location:
  • Phone: 479-273-9056
  • Fax: 479-273-6937
Mailing address:
  • Phone: 479-273-9056
  • Fax: 479-273-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01870
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR72705
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: