Provider Demographics
NPI:1245307586
Name:MAPLES, KATHLEEN M (APN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:MAPLES
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 1:485 HWY 124
Mailing Address - Street 2:PO BOX 153
Mailing Address - City:PANGBURN
Mailing Address - State:AR
Mailing Address - Zip Code:72121
Mailing Address - Country:US
Mailing Address - Phone:501-658-2718
Mailing Address - Fax:
Practice Address - Street 1:200 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4223
Practice Address - Country:US
Practice Address - Phone:501-658-2718
Practice Address - Fax:501-724-3305
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164961758Medicaid
AR57297Medicare PIN
AR164961758Medicaid
AROTH000Medicare UPIN
AR5T7761817Medicare Oscar/Certification
AR5T7761828Medicare Oscar/Certification
AR5T7761847Medicare Oscar/Certification