Healthcare Provider Details

I. General information

NPI: 1679392393
Provider Name (Legal Business Name): KRISTINA F MILLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA F DESOTO

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 RODGERS DR STE A
SEARCY AR
72143-7434
US

IV. Provider business mailing address

415 RODGERS DR STE A415
SEARCY AR
72143-7434
US

V. Phone/Fax

Practice location:
  • Phone: 501-278-3297
  • Fax:
Mailing address:
  • Phone: 501-278-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123581
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: