Hessel Kooistra III, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

E-2570 Issued in AR

Practice address

10971 Rocky Creek Rd
Fayetteville, AR 72701-0614

Phone

(479) 841-2736

NPI assigned

Apr 12, 2013

Last updated

Apr 12, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365724800000",
    "number": "1053754622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10975 ROCKY CREEK RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727010614",
            "telephone_number": "479-841-2736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10971 ROCKY CREEK RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727010614",
            "telephone_number": "479-841-2736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOISTRA",
        "first_name": "HESSEL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-12",
        "last_updated": "2013-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AR",
            "license": "E-2570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P000516J3",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily L Koelsch, RN, CPNP-PC
• Michael John Koenigs, PHARMD
• Peter Ogden Kohler, M.D.
• Aye Koko, M.D.
• Anh Dao Kolbe
• Linda Marie Kooistra, D.C.
• Abigail Marie Korpella
• Shelby Koshy
• Mark Andrew Kostelnik, PHARMD, BCPS
• Ashley Kotchin

• General Practice Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• General Practice Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.