Healthcare Provider Details

I. General information

NPI: 1891821153
Provider Name (Legal Business Name): KIM S ALLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W GROVE ST
EL DORADO AR
71730-4416
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 870-864-4100
  • Fax: 870-864-3555
Mailing address:
  • Phone: 870-864-4100
  • Fax: 870-864-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number220802
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number220802
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: