Provider Demographics
NPI:1124902002
Name:LY, KINSEY BROOKE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KINSEY
Middle Name:BROOKE
Last Name:LY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KINSEY
Other - Middle Name:BROOKE
Other - Last Name:FREIBURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 PONTALBA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2128
Mailing Address - Country:US
Mailing Address - Phone:870-416-8798
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPENDING363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care