Healthcare Provider Details

I. General information

NPI: 1326222183
Provider Name (Legal Business Name): SUSAN KIMBRELL CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 HORSEBARN RD STE 101
ROGERS AR
72758-8797
US

IV. Provider business mailing address

593 HORSEBARN RD STE 101
ROGERS AR
72758-8797
US

V. Phone/Fax

Practice location:
  • Phone: 479-271-9191
  • Fax: 479-271-9196
Mailing address:
  • Phone: 479-271-9191
  • Fax: 479-271-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberS02219 CNS
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: