Healthcare Provider Details

I. General information

NPI: 1336079433
Provider Name (Legal Business Name): NICHOLAS MARTIN KITCHENS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD STE 500
LITTLE ROCK AR
72205-6389
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-4715
  • Fax: 501-202-4755
Mailing address:
  • Phone: 501-202-4715
  • Fax: 501-202-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number237848
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: