Provider Demographics
NPI:1760784771
Name:AMYETT, KYMBERLY ROBIN (APN)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:ROBIN
Last Name:AMYETT
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 1:14309 CANTRELL RD
Mailing Address - Street 2:#7
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4217
Mailing Address - Country:US
Mailing Address - Phone:501-224-6727
Mailing Address - Fax:
Practice Address - Street 1:14309 CANTRELL RD
Practice Address - Street 2:#7
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4217
Practice Address - Country:US
Practice Address - Phone:501-224-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184836758Medicaid
5V761Medicare PIN