Healthcare Provider Details

I. General information

NPI: 1730803164
Provider Name (Legal Business Name): LESLIE BROOKE KIMES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE 1
HARRISON AR
72601-2939
US

IV. Provider business mailing address

825 N MAIN ST STE 1
HARRISON AR
72601-2939
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-4900
  • Fax: 870-743-4949
Mailing address:
  • Phone: 870-743-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221714
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: