Healthcare Provider Details

I. General information

NPI: 1639831274
Provider Name (Legal Business Name): KRISTAL NEWLIN MSN, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 S 70TH ST
FORT SMITH AR
72903-5050
US

IV. Provider business mailing address

3224 S 70TH ST
FORT SMITH AR
72903-5050
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-4810
  • Fax: 479-314-4829
Mailing address:
  • Phone: 479-314-4810
  • Fax: 479-314-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number216638
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: