Healthcare Provider Details

I. General information

NPI: 1689267742
Provider Name (Legal Business Name): NOAH KYLE RISNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W KIMBERLY DRIVE
MCCRORY AR
72101-8539
US

IV. Provider business mailing address

115 W KIMBERLY DRIVE
MCCRORY AR
72101-8539
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-0640
  • Fax: 870-731-0655
Mailing address:
  • Phone: 870-731-0640
  • Fax: 870-731-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE20428
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: