Provider Demographics
NPI:1659778827
Name:RHODES, KIMBERLY D (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:RHODES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 844
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-2090
Mailing Address - Fax:501-364-3929
Practice Address - Street 1:2601 GENE GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0845
Practice Address - Country:US
Practice Address - Phone:479-725-6801
Practice Address - Fax:479-725-6577
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200573910AMedicaid
MO420039646Medicaid
AR205841758Medicaid