Provider Demographics
NPI:1760929822
Name:GEORGE, MOLLY KYLE (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KYLE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:KYLE
Other - Last Name:ABEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3501 OLD GREENWOOD RD STE 10
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5964
Mailing Address - Country:US
Mailing Address - Phone:479-226-5212
Mailing Address - Fax:
Practice Address - Street 1:3501 OLD GREENWOOD RD STE 10
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5964
Practice Address - Country:US
Practice Address - Phone:479-226-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133057363LF0000X
AR230368363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily