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NPI Code Detail

MEDICARE: MOLLY KYLE BROSSARD NP

MEDICARE:   MOLLY KYLE BROSSARD  NP
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
1363LP2300XPrimary Care Nurse Practitioner230368AR

General Provider Information

NPI Number : 1760929822
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY KYLE BROSSARD NP
Provider Business Mailing Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-573-3083
Fax Number : 479-314-6159
Provider Business Practice Location Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-573-3083
Fax Number : 479-314-6159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2017
Last Update Date : 06/23/2026

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