Healthcare Provider Details

I. General information

NPI: 1265880926
Provider Name (Legal Business Name): VICTORIA KLAETSCH APRN-CNP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SUGAR CREEK RD
NORTH LITTLE ROCK AR
72116-6332
US

IV. Provider business mailing address

24 SUGAR CREEK RD
NORTH LITTLE ROCK AR
72116-6332
US

V. Phone/Fax

Practice location:
  • Phone: 501-258-3435
  • Fax:
Mailing address:
  • Phone: 501-258-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR086103
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL50867
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number228041
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: