Provider Demographics
NPI:1497484505
Name:WITKOWSKI, KINDRA DAYE (APRN)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:DAYE
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1979
Mailing Address - Country:US
Mailing Address - Phone:501-664-3700
Mailing Address - Fax:501-312-0694
Practice Address - Street 1:1521 MERRILL DRIVE
Practice Address - Street 2:SUITE D240
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1821
Practice Address - Country:US
Practice Address - Phone:501-664-3700
Practice Address - Fax:501-312-0694
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220352363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily