Healthcare Provider Details

I. General information

NPI: 1366287021
Provider Name (Legal Business Name): KASSIDY FRILLMAN MSN APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 HIGHWAY 62 E
MOUNTAIN HOME AR
72653-2714
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 870-706-2353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024022375
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: