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General NPI Number Information
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NPI Number | 1952491516
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Entity Type | Individual
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Provider Name | KIMO C STINE MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 1 CHILDRENS WAY # 512-10
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3500
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Country | US
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Telephone | 501-364-4374
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Fax | 501-364-6829
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Provider Business Mailing Address
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Address Line | 1 CHILDRENS WAY # 653
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City | LITTLE ROCK
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State | AR
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Zip | 72202-3500
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Country | US
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Telephone | 501-364-1100
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Fax | 501-364-4082
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N-8125
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | N-8125
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License Number State | AR
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