Healthcare Provider Details

I. General information

NPI: 1881845758
Provider Name (Legal Business Name): KIMBERLEY JO DONNER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 SOUTH GARFIELD
PIGGOTT AR
72454
US

IV. Provider business mailing address

498 LAMB DRIVE
PIGGOTT AR
72454
US

V. Phone/Fax

Practice location:
  • Phone: 870-598-3390
  • Fax:
Mailing address:
  • Phone: 870-598-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03139
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: