Healthcare Provider Details

I. General information

NPI: 1619896404
Provider Name (Legal Business Name): ALEXANDER HADDON KAPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4007
US

IV. Provider business mailing address

803 N LAKEVIEW DR
ROGERS AR
72756-3051
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-1000
  • Fax:
Mailing address:
  • Phone: 210-584-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number222926
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: