Healthcare Provider Details

I. General information

NPI: 1730296591
Provider Name (Legal Business Name): KIMBERLY L HERTLEIN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S 5TH ST
PARIS AR
72855-4501
US

IV. Provider business mailing address

PO BOX 3528
FORT SMITH AR
72913-3528
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-2132
  • Fax: 479-963-2046
Mailing address:
  • Phone: 479-274-2000
  • Fax: 479-274-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01805
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: