Provider Demographics
NPI:1083433403
Name:KYLE, GARRETT (FNP)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:KYLE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3743
Practice Address - Country:US
Practice Address - Phone:479-491-4141
Practice Address - Fax:479-491-4143
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-12-30
Deactivation Date:2024-10-04
Deactivation Code:
Reactivation Date:2024-11-29
Provider Licenses
StateLicense IDTaxonomies
AR231006363LF0000X
MO2024038773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily