Provider Demographics
NPI:1174685465
Name:NANCE, KIMBERLY DIANE (APRN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DIANE
Last Name:NANCE
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 HIGHWAY 71 N
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-8917
Mailing Address - Country:US
Mailing Address - Phone:479-394-4800
Mailing Address - Fax:479-394-4805
Practice Address - Street 1:1706 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-8917
Practice Address - Country:US
Practice Address - Phone:479-394-4800
Practice Address - Fax:479-394-4805
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163849758Medicaid
ARA01937OtherAR LICENSE
ARQ76792Medicare UPIN
AR163849758Medicaid