Healthcare Provider Details

I. General information

NPI: 1568294668
Provider Name (Legal Business Name): CORRYN KIMERY QBHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 HOBSON AVE
HOT SPRINGS AR
71913-3403
US

IV. Provider business mailing address

1310 W MAIN ST STE 201
RUSSELLVILLE AR
72801-2803
US

V. Phone/Fax

Practice location:
  • Phone: 501-566-4796
  • Fax: 501-501-2117
Mailing address:
  • Phone: 479-964-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: