Provider Demographics
NPI:1326222183
Name:KIMBRELL, SUSAN (CNS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 HORSEBARN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8797
Mailing Address - Country:US
Mailing Address - Phone:479-271-9191
Mailing Address - Fax:479-271-9196
Practice Address - Street 1:593 HORSEBARN RD STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8797
Practice Address - Country:US
Practice Address - Phone:479-271-9191
Practice Address - Fax:479-271-9196
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS02219 CNS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A727Medicare PIN