Healthcare Provider Details

I. General information

NPI: 1851027114
Provider Name (Legal Business Name): KOHLTON RILEY RHODA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOHLTON RILEY DAVIDSON

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16723 HIGHWAY 62
GARFIELD AR
72732-7007
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 479-359-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number192555
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: