Healthcare Provider Details

I. General information

NPI: 1508160102
Provider Name (Legal Business Name): CRISTYN NICOLE BRANSTETTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTYN NICOLE CAMET M.D.

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 GENE GEORGE BLVD
SPRINGDALE AR
72762
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-6801
  • Fax: 479-725-6577
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10030749
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-11200
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberN8893
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberE-11200
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: