Provider Demographics
NPI:1679501027
Name:CARNEY, KIMBERLY J (APN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:CARNEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7857
Mailing Address - Country:US
Mailing Address - Phone:479-273-9056
Mailing Address - Fax:479-273-6937
Practice Address - Street 1:1000 SE 13TH CT
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7857
Practice Address - Country:US
Practice Address - Phone:479-273-9056
Practice Address - Fax:479-273-6937
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01870363L00000X
ARR72705163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160045758Medicaid
AR160045758Medicaid
AR5Y556Medicare PIN