Basic Information
Provider Information
NPI: 1669679262
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARKELL
FirstName: KRISTIN
MiddleName: LYNN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 550
Address2:  
City: LOWELL
State: AR
PostalCode: 727450550
CountryCode: US
TelephoneNumber: 4794637775
FaxNumber: 4794637187
Practice Location
Address1: 3215 N NORTHHILLS BLVD
Address2: SUITE B
City: FAYETTEVILLE
State: AR
PostalCode: 72703
CountryCode: US
TelephoneNumber: 4794635500
FaxNumber: 4794635542
Other Information
ProviderEnumerationDate: 06/28/2007
LastUpdateDate: 11/21/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XE-5659ARY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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