Healthcare Provider Details

I. General information

NPI: 1558614008
Provider Name (Legal Business Name): MEGAN MICHELLE KUMPE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WILLOW CREEK DR. STE 203
SPRINGDALE AR
72762
US

IV. Provider business mailing address

5501 WILLOW CREEK DR. STE 203
SPRINGDALE AR
72762
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-9359
  • Fax:
Mailing address:
  • Phone: 479-575-9359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA003753
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: