Provider Demographics
NPI:1639831274
Name:NEWLIN, KRISTAL (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:NEWLIN
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5050
Mailing Address - Country:US
Mailing Address - Phone:479-314-4810
Mailing Address - Fax:479-314-4829
Practice Address - Street 1:3224 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5050
Practice Address - Country:US
Practice Address - Phone:479-314-4810
Practice Address - Fax:479-314-4829
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216638363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics