Healthcare Provider Details

I. General information

NPI: 1689800823
Provider Name (Legal Business Name): KIMBERLY EVINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E RACE AVE
SEARCY AR
72143-4331
US

IV. Provider business mailing address

4508 STADIUM BLVD
JONESBORO AR
72404-9675
US

V. Phone/Fax

Practice location:
  • Phone: 501-305-2359
  • Fax: 501-305-2348
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR67835
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: