Healthcare Provider Details

I. General information

NPI: 1629991880
Provider Name (Legal Business Name): KIMBERLY DIANE PERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

2700 BUTTERFIELD COACH RD
SPRINGDALE AR
72764-8767
US

IV. Provider business mailing address

1504 LEXINGTON CIR
SPRINGDALE AR
72762-8146
US

V. Phone/Fax

Practice location:
  • Phone: 479-957-0830
  • Fax:
Mailing address:
  • Phone: 479-957-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR066454
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: