Healthcare Provider Details

I. General information

NPI: 1609025840
Provider Name (Legal Business Name): KENDI HALL DEVORE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MARSHALL ST
LITTLE ROCK AR
72202-3510
US

IV. Provider business mailing address

800 MARSHALL ST
LITTLE ROCK AR
72202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1244
  • Fax:
Mailing address:
  • Phone: 501-364-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberA03161 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: