Healthcare Provider Details

I. General information

NPI: 1174457949
Provider Name (Legal Business Name): ANGELA KITCHEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 HIGHWAY 215
OARK AR
72852-8858
US

IV. Provider business mailing address

5095 COUNTY ROAD 5099
PETTIGREW AR
72752-8031
US

V. Phone/Fax

Practice location:
  • Phone: 479-292-3353
  • Fax:
Mailing address:
  • Phone: 979-417-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number83520
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: