Individual
BJ KIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3101 SE 14TH ST, BENTONVILLE, AR 72712-4900
(479) 250-1053
(479) 250-0923
Mailing address
3101 SE 14TH ST, BENTONVILLE, AR 72712-4900
(479) 250-1053
(479) 250-0923
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
218019
AR
363LF0000X
Family Nurse Practitioner
223761
LA
Other
Enumeration date
12/20/2021
Last updated
06/20/2023
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