Basic Information
| Provider Information | |||||||||
| NPI: | 1609165364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIKES | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | DARIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | A.P.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2731 MOUNTVISTA DR | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720198736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018445414 | ||||||||
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| Practice Location | |||||||||
| Address1: | 124 SAWTOOTH OAK ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719017160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016237800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2011 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A03527 APN | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.