Healthcare Provider Details

I. General information

NPI: 1053819417
Provider Name (Legal Business Name): KRISTEN PAIGE NELDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E OAK AVE
JONESBORO AR
72401-4163
US

IV. Provider business mailing address

225 E JACKSON AVE
JONESBORO AR
72401-3119
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-6729
  • Fax:
Mailing address:
  • Phone: 870-207-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005439
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA005439
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberA005439
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: