Healthcare Provider Details

I. General information

NPI: 1407779663
Provider Name (Legal Business Name): KIM BOLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 CARDINAL DR
SPRINGDALE AR
72764-5735
US

IV. Provider business mailing address

5218 N GRAHAM RD
SPRINGDALE AR
72762-8249
US

V. Phone/Fax

Practice location:
  • Phone: 479-790-2299
  • Fax:
Mailing address:
  • Phone: 479-790-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR044108
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: