Provider Demographics
NPI:1003635392
Name:MARKS, KIMBERLY MONIQUE (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MONIQUE
Last Name:MARKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HIDDEN VALLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6781
Mailing Address - Country:US
Mailing Address - Phone:903-276-7285
Mailing Address - Fax:
Practice Address - Street 1:524 CARPENTER DAM RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8213
Practice Address - Country:US
Practice Address - Phone:501-262-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily