Provider Demographics
NPI:1710943659
Name:SHEETS, KIM R (APN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:R
Last Name:SHEETS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E APPLEBY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3901
Mailing Address - Country:US
Mailing Address - Phone:479-463-4444
Mailing Address - Fax:479-463-4499
Practice Address - Street 1:12 E APPLEBY RD
Practice Address - Street 2:STE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3901
Practice Address - Country:US
Practice Address - Phone:479-463-4444
Practice Address - Fax:479-463-4499
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154402758Medicaid
AR5X450OtherBLUE
AR5X450OtherBLUE
G74409Medicare UPIN