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General NPI Number Information
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NPI Number | 1245387091
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Entity Type | Individual
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Provider Name | KIMBERLY JOY EMERSON M.D
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 903 SE 28TH ST SUITE 1
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City | BENTONVILLE
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State | AR
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Zip | 72712-3880
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Country | US
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Telephone | 479-464-8111
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Fax | 479-464-4475
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | LOWELL
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State | AR
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Zip | 72745-0188
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Country | US
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Telephone | 479-464-8111
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Fax | 479-464-4475
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E2176
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License Number State | AR
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