Healthcare Provider Details

I. General information

NPI: 1760929822
Provider Name (Legal Business Name): MOLLY KYLE BROSSARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY KYLE GEORGE NP

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 OLD GREENWOOD RD STE 10
FORT SMITH AR
72903-5964
US

IV. Provider business mailing address

2612 CLIFF DR
FORT SMITH AR
72901-7127
US

V. Phone/Fax

Practice location:
  • Phone: 479-226-5212
  • Fax:
Mailing address:
  • Phone: 651-269-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number230368
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: