Provider Demographics
NPI:1609305929
Name:HIDDLE, KAITLIN RENE (DNP, APRN, FNP-C, PM)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:RENE
Last Name:HIDDLE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C, PM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N. WALTON BLVD.
Mailing Address - Street 2:UNIT 6
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-855-5704
Mailing Address - Fax:479-268-4170
Practice Address - Street 1:701 N. WALTON BLVD. NORTHWEST COUNSELING INC.
Practice Address - Street 2:UNIT 6
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-855-5704
Practice Address - Fax:479-268-4170
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK107214163W00000X, 363LF0000X, 363LP0808X
AR221171363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily