Healthcare Provider Details

I. General information

NPI: 1760155121
Provider Name (Legal Business Name): KIMBERLY MARTIN CUDWORTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 NORTH SPRING STREET
HARRISON AR
72601-2918
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-6373
  • Fax: 870-741-5102
Mailing address:
  • Phone: 870-448-5733
  • Fax: 870-741-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216292
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: