Healthcare Provider Details

I. General information

NPI: 1255077160
Provider Name (Legal Business Name): KAYLA ANN ADAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 ROGERS AVE STE 101
FORT SMITH AR
72903-3121
US

IV. Provider business mailing address

4620 ROGERS AVE STE 101
FORT SMITH AR
72903-3121
US

V. Phone/Fax

Practice location:
  • Phone: 479-384-5380
  • Fax: 479-384-5382
Mailing address:
  • Phone: 479-384-5380
  • Fax: 479-384-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219611
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number219611
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: