Individual
KATHLEEN IDELLA-ROBICHAUD VASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, AGPCNP-BC
Contact information
Practice address
2200 ADA AVE STE 201, CONWAY, AR 72034-4984
(501) 852-1360
(501) 552-5316
Mailing address
PO BOX 9662, CONWAY, AR 72033-9662
(501) 852-1363
(501) 852-1364
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
A006157
AR
Other
Enumeration date
03/29/2019
Last updated
07/26/2023
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