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General NPI Number Information
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NPI Number | 1316694466
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Entity Type | Individual
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Provider Name | KIMBERLY VINACCO APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 1065 SKYLINE DR
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City | CONWAY
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State | AR
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Zip | 72032-3530
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Country | US
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Telephone | 501-499-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SETHSTONE DR
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City | GREENBRIER
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State | AR
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Zip | 72058-9290
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Country | US
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Telephone | 501-730-8160
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 124074
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License Number State | AR
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