Provider Demographics
NPI:1639496425
Name:BRECHEISEN, KYNDEL HOPE (APN)
Entity Type:Individual
Prefix:MRS
First Name:KYNDEL
Middle Name:HOPE
Last Name:BRECHEISEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:KYNDEL
Other - Middle Name:HOPE
Other - Last Name:KOVACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:609 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5335
Mailing Address - Country:US
Mailing Address - Phone:479-752-3980
Mailing Address - Fax:479-752-3994
Practice Address - Street 1:250 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AR
Practice Address - Zip Code:72722-9782
Practice Address - Country:US
Practice Address - Phone:479-752-3980
Practice Address - Fax:479-752-3994
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03362 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily