Healthcare Provider Details

I. General information

NPI: 1164186219
Provider Name (Legal Business Name): LISA M KOTTLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M CASTO

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 LINDSEY RD
LITTLE ROCK AR
72206-3877
US

IV. Provider business mailing address

PO BOX 23410
LITTLE ROCK AR
72221-3410
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-8860
  • Fax:
Mailing address:
  • Phone: 501-224-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214817
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: