Basic Information
| Provider Information | |||||||||
| NPI: | 1104052661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMBLAD | ||||||||
| FirstName: | KRISTEL | ||||||||
| MiddleName: | BRITT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 251418 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722251418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013641100 | ||||||||
| FaxNumber: | 5013644082 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 GENE GEORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797256880 | ||||||||
| FaxNumber: | 4797256582 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TD60599824 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | MD450033 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0214X | MD450033 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 2080P0214X | A145173 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 2080P0214X | E-15254 | AR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | P01683022 | 01 | WA | RR PTAN WVH | OTHER | 1104052661 | 05 | WA | MEDICAID | 1104052661 | 05 | CA | MEDICAID |