MEDICARE: KIMBERLY D STUCKEY R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	P01116	AR

General Provider Information

NPI Number	:	1184825721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY D STUCKEY R.N.P.

Provider Business Mailing Address
First Line	:	5701 N DETONTI RD
Second Line	:
City	:	BAUXITE
State	:	AR
Zip	:	72011-9635
Country	:	US
Telephone Number	:	501-778-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 N DETONTI RD
Second Line	:
City	:	BAUXITE
State	:	AR
Zip	:	72011-9635
Country	:	US
Telephone Number	:	501-778-3347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	10/16/2008

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Directions to “ KIMBERLY D STUCKEY R.N.P.” Practice Location

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