Healthcare Provider Details

I. General information

NPI: 1235196569
Provider Name (Legal Business Name): CYNTHIA KRESSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146A PASSION PLAY RD
EUREKA SPRINGS AR
72632
US

IV. Provider business mailing address

PO BOX 879
FAYETTEVILLE AR
72702-0879
US

V. Phone/Fax

Practice location:
  • Phone: 479-253-9746
  • Fax: 479-253-2464
Mailing address:
  • Phone: 479-713-7115
  • Fax: 479-713-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01139
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: