Healthcare Provider Details

I. General information

NPI: 1386071785
Provider Name (Legal Business Name): KATHLEEN JOY PRINNER ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 HOSPITAL DR STE 1-A
MOUNTAIN HOME AR
72653-2946
US

IV. Provider business mailing address

PO BOX 958539
SAINT LOUIS MO
63195-8539
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-3200
  • Fax: 870-508-1359
Mailing address:
  • Phone: 870-508-3200
  • Fax: 870-508-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberS002282
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: