Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2309 | AR |
NPI | 1033175203 |
---|---|
Provider Name | Kymbrly Hannah |
First Address | Fayetteville, AR 72703-4519 |
Second Address | Fayetteville, AR 72703-4519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5U424 | BLUE CROSS BLUE SHEILD (01) | AR |