Healthcare Provider Details

I. General information

NPI: 1528922291
Provider Name (Legal Business Name): MIKALEE BROOKE HINRICHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 HOSPITAL DR STE 1
MOUNTAIN HOME AR
72653-2912
US

IV. Provider business mailing address

505 HOSPITAL DR STE 1
MOUNTAIN HOME AR
72653-2912
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-3260
  • Fax: 870-508-1626
Mailing address:
  • Phone: 870-508-3260
  • Fax: 870-508-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215915
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: