Bluetail Arkansas PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

BLUETAIL ARKANSAS PLLC

Practice address

9101 Kanis Rd Ste 200
Little Rock, AR 72205-6455

Phone

(636) 778-2900

Fax

(636) 778-2828

NPI assigned

Sep 4, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Kristin S Oliver, MDNPI 1922116763

Title

Owner

Phone

(636) 778-2900

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin Suzanne Oliver, MD

  • Sports Medicine (Family Medicine) Physician
  • Eden, UT
  • NPI 1922116763
  NPD Authorized official

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1578045803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O BLUETAIL MEDICAL GROUP, LLC",
            "address_2": "17300 NORTH OUTER 40 RD, STE 201",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-778-2900",
            "fax_number": "636-778-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9101 KANIS RD STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056455",
            "telephone_number": "636-778-2900",
            "fax_number": "636-778-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUETAIL ARKANSAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-04",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-778-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Karli Renee Boatright
• Stephen W. Boatright, DDS, FAGD
• Joseph Boatwright, MSW
• Anthony Duane Boaz

• Sports Medicine (Family Medicine) Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Sports Medicine (Family Medicine) Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; 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.