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General NPI Number Information
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NPI Number | 1083433403
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Entity Type | Individual
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Provider Name | GARRETT KYLE FNP
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Gender | Male
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 409 S ROGERS ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830-3743
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Country | US
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Telephone | 479-491-4141
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Fax | 479-491-4143
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Provider Business Mailing Address
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Address Line | PO BOX 7411626
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City | CHICAGO
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State | IL
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Zip | 60674-5626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 231006
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024038773
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License Number State | MO
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