Healthcare Provider Details

I. General information

NPI: 1639496425
Provider Name (Legal Business Name): KYNDEL HOPE BRECHEISEN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYNDEL HOPE KOVACH RN

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MAIN ST
DECATUR AR
72722-9782
US

IV. Provider business mailing address

609 W MAPLE AVE
SPRINGDALE AR
72764-5335
US

V. Phone/Fax

Practice location:
  • Phone: 479-752-3980
  • Fax: 479-752-3994
Mailing address:
  • Phone: 479-752-3980
  • Fax: 479-752-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03362 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: