Healthcare Provider Details

I. General information

NPI: 1609165364
Provider Name (Legal Business Name): BRENT DARIN FIKES A.P.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SAWTOOTH OAK ST
HOT SPRINGS AR
71901-7160
US

IV. Provider business mailing address

2731 MOUNTVISTA DR
BENTON AR
72019-8736
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-7800
  • Fax:
Mailing address:
  • Phone: 501-844-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03527 APN
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: