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General NPI Number Information
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NPI Number | 1629754320
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Entity Type | Organization
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Legal Business Name | WALK IN FAITH, PLLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 906 S PINE ST STE 5
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City | CABOT
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State | AR
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Zip | 72023-3837
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Country | US
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Telephone | 501-422-6700
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Fax | 501-422-6710
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Provider Business Mailing Address
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Address Line | 906 S PINE ST STE 5
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City | CABOT
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State | AR
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Zip | 72023-3837
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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 | PEDIATRIC NURSE PRACTITIONER/OWNER
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Name | KIMBERLY MACCONAUGHA
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Credential | APRN, CPNP-PC
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Telephone | 501-422-6700
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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 |
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License Number State |
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