Provider Demographics
NPI:1588357537
Name:MCMAHAN, KRYSTAL KAY (APRN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:KAY
Last Name:MCMAHAN
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 1:27 GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7820
Mailing Address - Country:US
Mailing Address - Phone:870-818-7976
Mailing Address - Fax:
Practice Address - Street 1:9501 BAPTIST HEALTH DR STE 600
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6231
Practice Address - Country:US
Practice Address - Phone:501-227-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224428363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care