Active NPI
Kori McDaniel
- Licensed Practical Nurse
- Fayetteville, AR
National Provider Identifier
1306665625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- L055040
- Practice address
- 3434 N Crossover Rd
Fayetteville, AR 72703-4576 - Phone
- (479) 318-0122
- NPI assigned
- Oct 3, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L055040 | AR | Primary |
Addresses
Primary practice location
3434 N Crossover Rd
Fayetteville, AR 72703-4576
Mailing address
16516 Sandstone
Springdale, AR 72764-8508
Phone (479) 409-3786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L055040 | AR | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727913600000",
"number": "1306665625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16516 SANDSTONE",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727648508",
"telephone_number": "479-409-3786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3434 N CROSSOVER RD",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034576",
"telephone_number": "479-318-0122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDANIEL",
"first_name": "KORI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-03",
"last_updated": "2024-10-03",
"certification_date": "2024-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "AR",
"license": "L055040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.