Individual provider Active NPI

Kaylie Ann Kostyurenko, APN

  • Family Nurse Practitioner
  • Little Rock, AR
National Provider Identifier
1093585275
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
226618 Issued in AR
Practice address
800 Fair Park Blvd
Little Rock, AR 72204-1720
Phone
(501) 404-8007
Fax
(501) 904-3620
NPI assigned
Jan 8, 2024
Last updated
May 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 226618 AR Primary

Addresses

Primary practice location

800 Fair Park Blvd
Little Rock, AR 72204-1720

Mailing address

800 Fair Park Blvd
Little Rock, AR 72204-1720
Phone (501) 404-8007

Other names 1

  • Kaylie Adney Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240223000717 AR Practitioner - Nurse Practitioner 0840634317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthoarkansas PAGroup PAC ID 1456256031, 148 clinicians

Practice addresses (Care Compare)

800 Fair Park Blvd
Little Rock, AR 72204-1720
Phone (501) 500-3500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
226618ARMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orthoarkansas, PA CurrentSince Feb 19, 2024 Accepting new patients
Orthoarkansas, PA CurrentSince Feb 19, 2024 Accepting new patients
Orthoarkansas, PA Past Accepting new patients

Locations

353 Cash Rd SW
Camden, AR 71701
Phone (870) 836-8101

800 Fair Park Blvd
Little Rock, AR 72204
Phone (501) 404-8007

3480 Landers Rd
North Little Rock, AR 72117
Phone (501) 955-5519

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1093585275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 FAIR PARK BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722041720",
            "telephone_number": "501-404-8007",
            "fax_number": "501-904-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 FAIR PARK BLVD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722041720",
            "telephone_number": "501-404-8007",
            "fax_number": "501-904-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTYURENKO",
        "first_name": "KAYLIE",
        "middle_name": "ANN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-08",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "226618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLIE",
            "last_name": "ADNEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.