Individual provider Active NPI

Kendra Leann Fletcher, APRN

  • Pediatric Nurse Practitioner
  • Russellville, AR
National Provider Identifier
1912486648
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
A005755 Issued in AR
Practice address
101 Skyline Dr
Russellville, AR 72801-3363
Phone
(479) 968-2345
NPI assigned
Aug 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X A005755 AR Primary

Addresses

Primary practice location

101 Skyline Dr
Russellville, AR 72801-3363

Mailing address

101 Skyline Dr
Russellville, AR 72801-3395
Phone (479) 968-2345

Other names 1

  • Miss Kendra Leann Hubbard 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
I20181022003081 AR Practitioner - Nurse Practitioner 7517210586 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A005755ARMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary'S Physician Services LLC CurrentSince Oct 15, 2018 Accepting new patients
St Marys Physician Services, LLC CurrentSince Oct 15, 2018 Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345

Interoperability endpoints

  • Direct secure messaging: kendra.hubbard.1@2433.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1912486648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SKYLINE DR",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013395",
            "telephone_number": "479-968-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SKYLINE DR",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013363",
            "telephone_number": "479-968-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "KENDRA",
        "middle_name": "LEANN",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AR",
            "license": "A005755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "HUBBARD",
            "middle_name": "LEANN",
            "prefix": "MISS",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.