Individual provider Active NPI

Kaitlin E Hartman

  • Psychiatric/Mental Health Nurse Practitioner
  • Bentonville, AR
National Provider Identifier
1295372290
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
122498 Issued in AR
Practice address
2508 SE 20TH St
Bentonville, AR 72712-4008
Phone
(479) 273-9088
Fax
(479) 750-4843
NPI assigned
Dec 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 122498 AR Primary

Addresses

Primary practice location

2508 SE 20TH St
Bentonville, AR 72712-4008

Mailing address

2400 S 48TH St
Springdale, AR 72762-6683
Phone (479) 750-2020

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
I20191231000603 AR Practitioner - Nurse Practitioner 8224462189 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ozark Guidance Center, IncGroup PAC ID 7214833730, 34 clinicians
Arisa Health IncGroup PAC ID 2264853829, 65 clinicians

Practice addresses (Care Compare)

2508 SE 20TH St
Bentonville, AR 72712-4008
Phone (479) 273-9088

2707 Browns LN
Jonesboro, AR 72401-7213
Phone (870) 972-4016

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
122498ARMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arisa Health, Inc. CurrentSince Jul 19, 2023 Accepting new patients
Arisa Health, Inc. Psychiatric/Mental Health CurrentSince Jul 19, 2023 Accepting new patients
Ozark Guidance Center, Inc CurrentSince Dec 9, 2019 Accepting new patients
Ozark Guidance Center, Inc CurrentSince Dec 9, 2019 Accepting new patients

Locations

2508 SE 20th St
Bentonville, AR 72712
Phone (479) 273-9088

1104 N College St
Huntsville, AR 72740
Phone (479) 738-2878

2707 Browns Ln
Jonesboro, AR 72401
Phone (870) 972-4000

2400 S 48th St
Springdale, AR 72762
Phone (479) 725-5115

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1295372290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626683",
            "telephone_number": "479-750-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 SE 20TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124008",
            "telephone_number": "479-273-9088",
            "fax_number": "479-750-4843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTMAN",
        "first_name": "KAITLIN",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-09",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "122498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.