Healthcare Provider Details

I. General information

NPI: 1396667754
Provider Name (Legal Business Name): KIMBERLY DAWN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 LINWOOD DR
PARAGOULD AR
72450-8833
US

IV. Provider business mailing address

4601 LINWOOD DR
PARAGOULD AR
72450-8833
US

V. Phone/Fax

Practice location:
  • Phone: 870-215-4460
  • Fax:
Mailing address:
  • Phone: 870-215-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR071111
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: