Healthcare Provider Details

I. General information

NPI: 1689499568
Provider Name (Legal Business Name): KIMBERLY SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 FINANCIAL CENTRE PKWY STE 485
LITTLE ROCK AR
72211-3539
US

IV. Provider business mailing address

38 SNYDER LN
DE WITT AR
72042-9344
US

V. Phone/Fax

Practice location:
  • Phone: 501-255-7375
  • Fax: 866-716-1451
Mailing address:
  • Phone: 501-266-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRO65264
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: