Healthcare Provider Details

I. General information

NPI: 1013308436
Provider Name (Legal Business Name): MEAGHAN DANIELLE KINGSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W MAIN ST STE C
WALNUT RIDGE AR
72476
US

IV. Provider business mailing address

9146 HIGHWAY 63 N
BONO AR
72416-8153
US

V. Phone/Fax

Practice location:
  • Phone: 870-930-9990
  • Fax: 870-930-9992
Mailing address:
  • Phone: 870-930-9990
  • Fax: 870-930-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004313
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: