Healthcare Provider Details

I. General information

NPI: 1497484505
Provider Name (Legal Business Name): KINDRA DAYE WITKOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 MERRILL DRIVE SUITE D240
LITTLE ROCK AR
72211-1821
US

IV. Provider business mailing address

P.O. BOX 251970
LITTLE ROCK AR
72225-1979
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-3700
  • Fax: 501-312-0694
Mailing address:
  • Phone: 501-664-3700
  • Fax: 501-312-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220352
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number220352
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: