Healthcare Provider Details

I. General information

NPI: 1811551336
Provider Name (Legal Business Name): FNP ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 S PINE ST STE B
CABOT AR
72023-3819
US

IV. Provider business mailing address

909 W MAIN ST STE 187
JACKSONVILLE AR
72076-4025
US

V. Phone/Fax

Practice location:
  • Phone: 501-580-6389
  • Fax:
Mailing address:
  • Phone: 501-580-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY M GRIFFITH
Title or Position: OWNER/APRN
Credential: FNP-BC
Phone: 501-422-6373