Healthcare Provider Details

I. General information

NPI: 1437829322
Provider Name (Legal Business Name): KRISTA F SANTIAGO MNSC, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SPRINGHILL RD STE 200
BRYANT AR
72019-7566
US

IV. Provider business mailing address

14612 RIDGEWOOD DR
LITTLE ROCK AR
72211-4558
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-2500
  • Fax:
Mailing address:
  • Phone: 501-730-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number214862
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: