Provider Demographics
NPI:1790701555
Name:CLINTON, KIMBERLY SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:CLINTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5076
Mailing Address - Country:US
Mailing Address - Phone:501-758-1530
Mailing Address - Fax:501-819-6171
Practice Address - Street 1:1525 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5076
Practice Address - Country:US
Practice Address - Phone:501-758-1530
Practice Address - Fax:501-819-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131535001Medicaid