Provider Demographics
NPI:1023525490
Name:SPANN, KORTNEY KAI
Entity type:Individual
Prefix:
First Name:KORTNEY
Middle Name:KAI
Last Name:SPANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 GABBY LN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1742
Mailing Address - Country:US
Mailing Address - Phone:501-317-5099
Mailing Address - Fax:
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 1200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6334
Practice Address - Country:US
Practice Address - Phone:501-664-4131
Practice Address - Fax:501-975-1798
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily