Kimberly T. Macconaugha, APN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

A03713 Issued in AR

Practice address

1 Childrens Way # 653
Little Rock, AR 72202

Phone

(501) 364-1100

Fax

(501) 526-6562

NPI assigned

Jun 13, 2012

Last updated

Mar 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.macconaugha@731385810714628.direct.elationemr.com

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.

• Walk in Faith, PLLC

  dba Cabot Health & Wellness

  • Family Medicine Physician
  • Cabot, AR
  • NPI 1629754320
  Medicare reassignment NPD Authorized official
• Arkansas Childrens Hospital

  dba ACH Physicians Billing Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1598773079
  Medicare reassignment NPD
• University of Arkansas for Medical Sciences

  dba Childrens University Medical Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1346230968
  Medicare reassignment NPD
• Arkansas Children's Hospital

  • Children's Hospital
  • Little Rock, AR
  • NPI 1477561983
  NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1851653117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1100",
            "fax_number": "501-526-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72202",
            "telephone_number": "501-364-1100",
            "fax_number": "501-526-6562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1106 S Pine St Ste B",
            "address_purpose": "LOCATION",
            "city": "Cabot",
            "state": "AR",
            "postal_code": "720233819",
            "country_code": "US",
            "telephone_number": "501-422-6373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACCONAUGHA",
        "first_name": "KIMBERLY",
        "middle_name": "T.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-13",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AR",
            "license": "A03713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN",
            "identifier": "A03713",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Thomas Mabrey, M.D.
• Allison Mabry, AU.D.
• Andrea Green Mabry, M.D.
• Mary Anne Mabry, OTR/L
• Vicki Lynn Mabry, APN
• Greta M Macdonald, APRN
• Billy Randall Machen, DDS PA
• Maci Scudder Therapy (Mindwave Therapy)
• Daylen Mack
• Delanie Mack

• Pediatric Nurse Practitioner in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Pediatric Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.